Early-Use of LAIs in Schizophrenia


Advice to physicians for early-use of LAIs when treating patients with schizophrenia.

Henry Nasrallah, MD: I strongly urge that we manage this illness as a highly recurring, destructive process and that we do have means to prevent it in most of the patients. Not all patients respond because there is a sub-group of patients who are treatment resistant to antipsychotics. We know that because schizophrenia is a heterogenous syndrome. There are several hundred types of schizophrenia we know that, from genetic causes and environmental causes. It is a huge syndrome of several hundred disorders. So, there is a sub-group of patients who are going to need clozapine. They do not respond to dopamine antagonists, which is the predominant first line antipsychotic therapy. 

So other than those patients, most of the rest do respond very well to long acting injectable. You can save their life give them back their life, return them to baseline, protect them, and do not let their brain experience psychotic relapse again. So, it is essential that we spread this message among both the professionals, the physicians, the nurse practitioners, but also among patients. We sometimes use advocacy groups like NAMI, who are just comprised of families who already know—knew what happens to their kids after many episodes. They see their children, sons, and daughters, totally disabled. 

Those are the families that we sometimes bring in to talk to the first episode families. To tell them, this is what happens if you do not protect your child from relapse. So, it is really an effort across the medical professionals, the family, the advocacy group, and the patients themselves. If we work together, we can defeat this illness, at least the recurrence of psychotic episodes. We do not have a cure for schizophrenia yet. Until we find a cure, the best thing we can do is protect the patients from the psychotic relapses. Because that is the malignant part of schizophrenia. The psychotic relapses is what destroys their brain.

Transcript Edited for Clarity

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