Long-acting neuroleptics and therapeutic relationship

A pharmacological treatment with long-acting neuroleptic (LANs) is not a substitute for the psychological treatment, but it facilitates it on the condition that patient care is not reduced to an automatic injection ritual: the patient should be encouraged to express his fears or prejudices in regard to the LAN, whereas the psychiatrist should prefer flexibility to the rigidity of dosage and intervals. Since the introduction of LANs in his University Hospital a decade ago, the author has noticed an increased motivation of the doctors from the inpatients' Department to follow-up their patients personally, an increased participation of nurses to a dual vs. triangular patient-nurse vs. physician-nurse relationship (hence a less massive fixation of chronic psychotics to one therapist), a decreased anxiety of relatives regarding their responsibility of ensuring that the patient does take his tablets, and a greater incentive for patients to attend the consultations in order to get their injection. Claims of an increased dependence are not established by the literature; in most cases, the refusal of the LAN reflects psychosis.