Tokyo, Japan – A Japanese case report details a prosperous shift from covert administration of oral antipsychotic medication to a patient-consented, long-acting injectable (LAI) antipsychotic regimen in a 47-year-old man diagnosed with schizophrenia, offering a potential model for navigating ethically complex treatment transitions. Published in Psychiatry and Clinical Neurosciences, the case highlights a pathway to increased patient autonomy and improved adherence in managing severe mental illness.
The patient, initially receiving involuntary oral antipsychotics due to non-adherence and resulting hospitalizations, demonstrated a willingness to transition to LAI therapy after a period of trust-building and collaborative discussion with his treatment team.This case is notably relevant given ongoing debates surrounding involuntary medication and the push for patient-centered care, impacting an estimated 24 million people globally living with schizophrenia. Successful transitions like this could reduce reliance on coercive measures, improve treatment outcomes, and enhance the quality of life for individuals with schizophrenia and their families.
The patient’s history revealed a 30-year course of schizophrenia characterized by intermittent periods of medication adherence followed by relapse and hospitalization. Prior to the transition, covert administration of oral risperidone was employed to manage acute psychotic symptoms.However,this approach raised ethical concerns and was deemed unsustainable long-term. The team initiated a phased approach, first establishing a therapeutic alliance, then educating the patient about the benefits and potential side effects of LAI antipsychotics – specifically, olanzapine pamoate.following informed consent, the patient began receiving olanzapine pamoate injections every four weeks. Throughout the 18-month follow-up period, the patient maintained stable mental health, experienced no critically important adverse effects, and remained committed to the LAI regimen. Researchers noted a marked advancement in the patient’s overall functioning and a reduction in hospitalizations.
“This case demonstrates the feasibility of transitioning patients from covert medication to LAI antipsychotics when a strong therapeutic relationship is established and the patient is actively involved in the decision-making process,” stated the report’s authors. Further research is needed to determine the generalizability of these findings and to develop standardized protocols for facilitating similar transitions in diverse clinical settings. The authors suggest that prioritizing patient autonomy and shared decision-making can lead to more effective and ethical treatment strategies for individuals with schizophrenia.
