Comparative effects on the clinical outcome, rehospitalizations and quality of life between community and inmate sufferers from Serious Mental Illness

Erasmia I. Koiliari^1,2,3*Iannis Mouzas^1,4Georgios Alevizopoulos^5,6Otto Lesch⁷Henriette Walter⁷Emmanouil L. Pasparakis^1,4*

• ¹Department of Psychiatry, General Hospital of Agios Nikolaos, Lasithi, Greece, Agios Nikolaos of Crete, Greece, Greece
• ²Laboratory of Alchohology, School of Medicine, University of Crete, Heraklion, Greece
• ³School of Medicine, Department of Pathology, University General Hospital of Irakleion (PAGNI), Herakleion, Greece
• ⁴Laboratory of Alcohology, School of Medicine, University of Crete, Heraklion, Greece
• ⁵National and Kapodistrian University of Athens, Athens, Greece
• ⁶Department of Psychiatry, Agioi Anargyroi Hospital, Athens, Greece
• ⁷Department of Social Psychiatry, Medical University of Vienna, Vienna, Austria

Aripiprazole, a D2 receptor partial agonist is suggested to enhance Prefrontal Cortex (PFC) dopamine functioning resulting to an improvement of working memory and GABA transmission related to social functioning. The long-acting injectable (LAI) form of the antipsychotics is documented to improve the long-term adherence of the patients resulting in a better effect of the drug on behavioral parameters that require a longer time to evaluate.To test the hypothesis that aripiprazole LAI antipsychotic treatment is associated with better general functioning, improved quality of life, and reduced hospitalizations in both psychotic patients in the community and inmates.Fifty-five patients participated in the study of whom 21 were incarcerated in a prison of the South-Eastern Greece (Neapolis). For the evaluation of our hypothesis the WHOQOL-BREF questionnaire and the CGI-S scale were used. Quality of life, functionality, and number of hospitalizations were compared in each patient group, before the initiation of the LAI medication and during the active treatment period. The shortest follow-up period was 6 months.The 34 patients from the community were men 70.6%, 44.1% had paranoid schizophrenia, The 21 Incarcerated patients were all men, F29.0 diagnosis, 57.1% Cluster B personality disorder, all used psychoactive substances.Hospitalizations: Community patients' hospitalizations dropped from 1.4 to 0.1 in six months post-Aripiprazole depot (p=0.001). Incarcerated patients' hospitalizations fell from 0.6 to 0.0 (p=0.066). Reduction wasn't significantly different between groups (p=0.150).Community patients' CGI-S scores improved from 6.0 to 3.9 (p<0.001). Incarcerated patients' scores improved from 5.3 to 3.2 (p<0.001). No significant difference between groups (p=0.814).Community patients' quality of life scores rose from 0.5 to 3.0 (p<0.001). Incarcerated patients' scores increased significantly as well (p<0.001).In our study of 34 community patients and 21 incarcerated patients, significant differences were found in demographics and medical history. Both groups showed a reduction in hospitalizations and improvements in CGI-S scores and quality of life after Aripiprazole depot administration. Community patients had a greater reduction in hospitalizations, while both groups saw similar improvements in clinical and quality of life measures. Aripiprazole LAI significantly improved the quality of life and functionality of patients that participated in the study.