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Psych CASC / OSCEPsychopharmacology — long-acting injectable antipsychotics

Psych CASC / OSCE · Psychopharmacology — long-acting injectable antipsychotics

Discussing a long-acting injectable with a young adult and parent (CASC)

CASC-style communication station: shared decision on LAI after early relapses, oral overlap explanation, benefits and risks, and boundary that LAI is not punishment.

communication2 min readVerification in progress

Target exams

FRANZCPMRCPsychABPNMD-DNB
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Target exams

FRANZCPMRCPsychABPNMD-DNB
Prompt
A 22-year-old with first-episode schizophrenia and his mother attend. He stopped oral aripiprazole twice 'because I felt fine' and was re-admitted. The team suggests a monthly injection. He fears needles and 'being controlled'. Mother wants 'anything that stops the hospital'.

Station instructions (candidate)

You have 7 minutes. Explain why a long-acting injectable is being offered after early relapses linked to missed tablets. Use plain language. Address needle fear and control concerns. Outline roughly how initiation works (tolerability already known on oral aripiprazole; short oral cover after first monthly injection). Balance benefits (fewer gaps in medicine, lower chance of another admission — early-phase and real-world evidence in simple terms) against side effects similar to the tablet and injection-site discomfort. Do not coerce. Do not promise cure. Do not present LAI as punishment. Check understanding and agree a next step (think time, written info, or start plan).[1][2][3]

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References5ShowHide
  1. [1]Kane JM, Schooler NR, Marcy P, et al. Effect of Long-Acting Injectable Antipsychotics vs Usual Care on Time to First Hospitalization in Early-Phase Schizophrenia: A Randomized Clinical Trial JAMA Psychiatry, 2020.PMID 32667636
  2. [2]Tiihonen J, Haukka J, Taylor M, et al. A nationwide cohort study of oral and depot antipsychotics after first hospitalization for schizophrenia Am J Psychiatry, 2011.PMID 21362741
  3. [3]Kishimoto T, Hagi K, Kurokawa S, et al. Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia: a systematic review and comparative meta-analysis of randomised, cohort, and pre-post studies Lancet Psychiatry, 2021.PMID 33862018
  4. [4]Subotnik KL, Casaus LR, Ventura J, et al. Long-Acting Injectable Risperidone for Relapse Prevention and Control of Breakthrough Symptoms After a Recent First Episode of Schizophrenia. A Randomized Clinical Trial JAMA Psychiatry, 2015.PMID 26107752
  5. [5]Howes OD, McCutcheon R, Agid O, et al. Treatment-Resistant Schizophrenia: Treatment Response and Resistance in Psychosis (TRRIP) Working Group Consensus Guidelines on Diagnosis and Terminology Am J Psychiatry, 2017.PMID 27919182
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