A retrospective study of the role of long-acting injectable antipsychotics in preventing rehospitalization in early psychosis with cannabis use

BACKGROUND: Despite compelling evidence that cannabis use is associated with neurocognitive deficits, loss of cerebral gray matter, relapse and rehospitalization, a substantial number of individuals with early psychosis continue to use recreational or medicinal marijuana. One identified pathway to relapse is non-adherence. Recurrent relapses modify the trajectory of illness and culminate in long-term disability. Long-acting antipsychotic medications are superior to oral equivalents in preventing relapse. PURPOSE: The current paper sought to examine the role of long-acting antipsychotics in preventing relapse in cannabis using early psychosis patients. METHODS: The present retrospective study, which was based in an early psychosis program in mid-Michigan, examined the association between patient perceptions of antipsychotic medication and subsequent rehospitalization, among cannabis users (n = 24) and non-users (n = 27). Patient perceptions of antipsychotic medications were assessed using a single question from the NAVIGATE Patient Self-Rating Form: “Between now and your next visit, do you think we should keep your medication the same, or consider changing the medication?”. RESULTS: Cannabis users were substantially more likely to report dissatisfaction with antipsychotic medication (Pearson Chi-square 9.67, df = 1.0, p < 0.002), and more likely to experience rehospitalization (Pearson Chi-square 4.40, df = 1.0, p = 0.036). Those maintained on long-acting injectable antipsychotic medications were rehospitalized less frequently when compared to others maintained on oral formulations (Pearson Chi-square 4.61, df = 1.0, p = 0.032). CONCLUSIONS: Dissatisfaction with antipsychotics may predict non-adherence and subsequent rehospitalization in early psychosis patients who use cannabis. Long-acting antipsychotics may prevent rehospitalization.