In short, plasma antipsychotic levels offer an opportunity to have a richer, evidence-based discussion about adherence, beyond the trite, ineffective question “Did you take your medication?” Use of an objective measure can (1) serve as a benchmark for the patient (eg, “You seemed to do better when your clozapine level was above 400 ng/mL”), and (2) remind clinicians of the variable adherence inherent with oral medication regimens.
A note about long-acting injectable antipsychotics
Because nonadherence is seen throughout the course of schizophrenia, discussion of LAI therapy should not be limited to patients with chronic illness. Results of recent naturalistic7 and randomized studies8 show significant reduction in the rate of psychotic relapse and improved symptom control8 among first-episode patients who are taking an LAI. Moreover, compelling data show that most first-episode patients who are taking an oral antipsychotic will accept a recommendation for treatment with an LAI.9
Summing up: 2 Tools for achieving therapeutic success
Monitoring plasma levels of antipsychotics offers a method for quantifying the problem of nonadherence. For many patients, an LAI antipsychotic provides a solution to nonadherence, and the increasing variety of LAI preparations means more options with which to match individual patients.
Clinicians have a limited amount of time to spend with patients in the office, but time spent discussing LAIs is an investment in the patient’s stability and functional outcome. Minutes once spent managing nonadherence can be devoted to understanding the patient’s aspirations and to developing strategies to achieve those goals.
In the end, isn’t that what we’d rather be talking about with our patients?