Long Acting Injectable Antipsychotics: Ongoing use during the COVID-19 pandemic and successful use of internet-based support in Greece

Long Acting Injectable Antipsychotics (LAIs) are considered the golden standard treatment option for non-adherent patients suffering from schizophrenia.¹ Psychotic illnesses impair patients’ insight and judgment and set them at significant risk for medication nonadherence.²

When the Coronavirus Pandemic (SARS-CoV-2) first hit Europe, in spring of 2020, mental health systems had to balance the risks of the visits of the patients to mental health care facilities against continuity of care and medication adherence.

In Greece the National Health Organization advised health care providers to limit non-urgent hospital visits and procedures and to employ telemedicine, when applicable, as a series of action to reduce the risk of contamination of vulnerable individuals. Nevertheless, many Mental Health Care authorities, decided to ensure the continuation of visits, since the administration of LAIs is an essential clinical procedure to avoid medication non-adherence. The above decision was supported in a recently published COVID-19 Pandemic Guidance Document by the American Psychiatric Association that encourages hospitals and other facilities to include the ongoing use of LAIs for patients with high-risk of chronic illness as a necessary procedure.³

At the Depot Clinic of the University Psychiatric Clinic of the General and Oncology Hospital of Athens, the Health Care Team decided to implement a Guidance Protocol for all patients receiving LAIs to ensure continuity of care as long with patient and staff safety during the pandemic. All involved staff jointly reviewed the guidance protocol and ensured patients and caregivers that all aspects were clear and understood. The protocol included guidance for patients on how to safely approach our setting, screening via phone before arrival for COVID-19 symptoms, and guidance of all the protective equipment necessary both for patients and nursing staff administering the injection. A copy of the protocol was provided to all patients and caregivers. A delayed injection schedule was not agreed to be implemented, since administration outside the approved schedules is an off-label practice, unless LAIs have been approved to be given in flexible intervals.

The protocol was also available online, since April 2020, via the hospital’s and the University’s sites, to ensure accessibility, not only to the patients of the clinic, but also to any other concerned person. This initiative was treated with scepticism regarding its value in real life conditions.

According to the Hellenic Statistical Authority for 2020, the use of information and communication technologies (ICT) by households and their members is significantly low compared to other European countries. In Greece 78.7% of the population did not conduct any learning activity online.⁴ Notably, there were more than 2000 “hits” on the site of our protocol, within a period of three months and subsequently many of our virtual visitors asked relevant questions. These numbers transcended by far our expectations, since only a small number of the patients who suffer from schizophrenia is on LAI antipsychotic treatment⁵ and psychotic patients and their caregivers are not familiar with digital technologies.

By the end of summer 2020, there were concerns about the limited access options to the Depot Clinic since Greece is experiencing the second lock-down since the pandemic struck. Surprisingly, numbers of visits remained practically unchanged from the pre-pandemic period. Our results are consistent with a recent report published by University of Pittsburgh Medical Centre Western Psychiatric Hospital.⁶

The success of patients safely remaining on their treatment can be attributed to several factors. The Depot Clinic of the of the University Psychiatric Clinic of the General and Oncology Hospital of Athens is one of the first depot clinics established in Greece. The nursing staff has a long experience and they have established a therapeutic relationship with all patients, some of whom are under our care for more than 10 years. We strongly support that maintaining an effective treatment and established course of therapy during uncertain times is particularly important⁷ and that the use of internet provided support can be extremely helpful for the most vulnerable part of our population.

Ethical considerations

None.

Funding

None.

Conflict of interest

None.