b'Pandemic Shows Value of Long-Acting Injectables for Severe Mental IllnessCommonly Prescribed Antipsychotic Medications. u From Page 39VAresearchhasfoundthat about half of veterans with diag-nosed schizophrenia or bipolar I disorder have attempted sui-cide.Nearly70%ofveterans withschizophrenia,andmore than 82% of those with bipolar disorder reported suicidal ide-ation or behavior. 1Antipsychoticmedications have been delivered by injec-tion for years, and a growing number are available that offer extended coverage.u nderuTilizedo pTionTheyreaverygoodop-tion for nonadherent patients. Unfortunately, they are under-utilized for a variety of patient Marder SR, Cannon TD. N Engl J Med 2019;381:1753-1761 andproviderfactors,SaxonSource: Marder SR, Cannon TD. N Engl J Med 2019;381:1753-1761said. Inmostsettings,providers finditeasiertosubmitanelectroniccleanpatientswithjustonedisorderAristada every six weeks or every two prescription than to order an injection,that may not reflect a truly randomizedmonths.but thats less true at the VA.patient sample. I believe the observa- Arranging injections every two weeks IntheVAitseasier,becausewetional evidence. for Risperdal Consta patients may be too haveastronginterdisciplinarystaffdifficult. A move to Invega Sustenna and resources, which makes it easier toa djusTinglai s or Trinza may be reasonable for these arrangeinjections.Forprivatepracti- TheAPAandSAMHSAprovideapatients, according to the SMI Adviser.tioners, there are more logistics to navi- numberofsuggestionsformanagingForpatientsinisolationorquaran-gate, including whos going to give thepatients on LAIs during the pandemic,tine,followingtheinformationon injection, Saxon suggested.including arranging a local injection inmisseddosesonpackageguidelines Randomized controlled trials may alsoa local clinic or pharmacy or providingcan be helpful. For some medications have contributed to underutilization. injections as part of an in-home visit.and patients, giving a higher dose than Its an interesting situation, becauseIn some cases, family members with ausual may provide a buffer in case the randomized controlled trials comparingmedical background might be trained tonext injection must be delayed. injections and oral self-administrationgive an injection, although that wouldWhile maintaining an injectable is best, havenotshownreductionintheendnot be consistent with their labeling. staying on an antipsychotic of some form pointofrehospitalizationofschizo- Whiletheremaybeconcernaboutisessential,theSMI Advisersaid.If phreniawithseriousrelapse,Saxonchangingmedicationsduringapan- giving a LAI is not possible, temporarily explained. demic,theorganizationsrecom- prescribe oral medications again.Hisexperiencewithpatientsandmended some low-risk changes within1Harvey PD, Posner K, Rajeevan N, Yershova observationalstudiesruncountertothe same medication that can increaseKV, Aslan M, Concato J. Suicidal ideation thefindingsoftheRCTs,however.thetimebetweeninjections.Thoseand behavior in US veterans with schizo-ObservationalstudieshaveshowedincludemigratingInvegaSustennaphrenia or bipolar disorder. J Psychiatr Res. tremendousadvantagetoinjections,patientstoTrinza,movingfrom2018;102:216-222. doi:10.1016/j.jpsy-Saxon noted. Often RCTs get squeakymonthly Aristada injections to dosingchires.2018.04.0142020 COMPENDIUM OF FEDERAL MEDICINE 49'