Brooke Kempf: LAIs Provide More Than Just Adherence to Schizophrenia Treatment

The growing utilization of long-acting injectable (LAI) medications for treating patients with schizophrenia indicates a positive trend in mental health practice, according to Brooke Kempf, PMHNP, Indiana University Indianapolis. Kempf is a psychiatric mental health nurse practitioner (PMHNP) from Terre Haute, Indiana, who has dedicated nearly 3 decades to mental health care. Starting her career in 1995 as a psychiatric nurse, Kempf has worked in various settings, including inpatient and outpatient care, group homes, and Assertive Community Treatment teams.

Initially reserved for patients who were nonadherent to medication, LAIs are now being used earlier in treatment for their convenience and benefits. Kempf explains why this approach is impacting the care and lives of those with schizophrenia in an interview.

This transcript has been lightly edited for clarity.

Transcript

Can you describe the shift in practice you've seen regarding the use of long-acting injectable (LAI) medications for schizophrenia?

I've definitely seen a shift, and I'm glad it's a very positive shift. One of the initial things that I would emphasize most is I see, rather than saving long-acting injectables for the worst-case scenario and only for individuals that are nonadherent to medication or don't take their medicines, they failed everything else, so we're just going to give them a long-acting injectable. We are now thinking of this differently. We are thinking of utilizing these earlier in treatment and just out of convenience.

Long-acting injectables are used across multiple disease states and different areas of medicine. And so I think it's becoming more acceptable in mental health also, and thinking of it differently—rather than as a punitive for only people that don't take their medicine—maybe this could be a benefit. So you don't have to be thinking about this every day, and "I have to take a pill every single day." There's a whole lot more that we need to be working on in the illness itself, let alone just having to worry about medication adherence. So I do see a shift, rather than just for nonadherence, but more for convenience, and just looking at the overall benefits of decreasing hospitalizations and so forth that come along with long-acting injectables.

You mentioned that LAIs are no longer seen as a "last resort" for patients with schizophrenia. What factors have contributed to this change in thinking among health care professionals?

I think some of the things that contribute to the difference in the way we're thinking, first and foremost, are that we now have newer medications that are offered in long-acting injectables. Prior, we only had typical antipsychotics that were often not utilized. But now that we have atypical antipsychotic options, we might think of using those early in treatment or more frequently in treatment, but also, the long-acting injectables themselves have changed, so they have to be given every 2 weeks. We've moved now to treatment options to offer monthly injections every 2 months, injections every 3 months. There's even an option for patients with schizophrenia where they only have to take an injection twice a year. So just thinking about that also opens up a whole new door to individuals who might be more accepting of taking the medicine.