USE OF LONG-ACTING INJECTABLE ANTIPSYCHOTICS IN FORENSIC PSYCHIATRY: A MULTI-SITE CANADIAN STUDY

Background

Long-acting injectable antipsychotics (LAI-As) are widely used in the treatment of psychotic disorders. Their use has been associated with several clinical advantages, including improved medication adherence, lower rates of treatment discontinuation, reduced hospitalizations, decreased relapse rates, lower overall healthcare costs, and reduced mortality. Despite these benefits, prescribing patterns for LAI-As vary considerably across countries, patient populations, and physician practice style. Hence, this study is designed to examine the prescribing patterns of LAI-A in forensic patients, and identify factors associated their use.

Methods

This retrospective multisite study was conducted using data derived from the Ontario Review board Database. he primary outcome variable was treatment with LAI-A, and factors associated with use of LAI-A were identified using logistic regression analysis, performed with STATA-17.

Results

A total of 1,205 participants were included. Majority were male (86.1%) and mean age of the cohort was 42.6 years (SD 13.4). Approximately 51.8% were inpatients with majority (91.6%) legally designated as Not Criminally Responsible (NCR) and 71.0% had documented history of substance use. Psychotic disorders were the most common primary diagnosis (81.6%) while violent offences accounted for the majority of index offences (70.0%). In total, 207 participants (17.2%) were prescribed at least one LAI-A (with a predominance of LAI -Abilify) during the reporting year. LAI-A use did not differ significantly by age or sex but varied across clinical, diagnostic, and legal characteristics. Compared with individuals with other diagnoses, those with psychotic disorders had significantly higher odds of receiving an LAI (adjusted odds ratio [aOR] = 7.81, 95% CI 2.34–25.04, p = 0.001). Similarly, participants diagnosed with mood disorders were substantially more likely to be prescribed an LAI (aOR = 12.19, 95% CI 3.38– 43.89, p < 0.001). In contrast, recent sexual violence was independently associated with lower odds of LAI use. Individuals with documented sexual violence during the reporting year were < half as likely to receive an LAI compared with those without such behaviour (aOR = 0.43, 95% CI 0.21–0.89, p = 0.023).

Conclusion

A significant proportion of forensic patients are treated with LAI-A, particularly those with severe psychotic-mood disorders and less likely in individuals with sexual violence. Capacity development and further research are needed to support an effective and safe LAI-A therapy strategy.