Caring for a Loved One During the Covid-19 Pandemic

(BPT) - Sponsored by Alkermes

In the midst of a global pandemic, Ashley and Kim, a Texas-based mother-daughter duo working together to treat Kim’s schizophrenia, have seen one surprising emotion rise to the surface: pride.

“She’s had some down days, but honestly I’m really proud of her. She’s handling the pandemic the best she can,” said Ashley, a caregiver for her mother Kim, who was diagnosed with schizophrenia when she was 30 years old.

While experts say that mental health challenges have become more widespread during the COVID-19 pandemic,¹ Ashley has seen some positive changes in her mother who lives with schizophrenia.

During this time, Ashley has seen her mom take positive steps to foster personal growth. With decreased outside pressures and commitments, her mother has taken time to focus on other aspects of her life, such as building and strengthening relationships and exploring her hobbies and interests. Spending more time at home has also allowed Kim the opportunity to fine-tune her daily routine, creating a calm, stable environment.

While Kim has experienced some improvement in her schizophrenia symptoms, for Ashley, the experience of caregiving has, at times, been challenging.

“Over the years, my mom has changed healthcare providers several times and tried different treatment options to help treat her schizophrenia symptoms,” said Ashley. “It’s challenging when you’re helping care for someone, especially a parent, while also being a young mom with three kids. We’ve really had to work together to treat her illness and we are trying to help her become more independent. For example, I've made certain that my mother has found a healthcare provider who was the right fit and who she could feel comfortable reaching out to whenever she needed. I've also encouraged her to be more social.”

About a year ago, Kim's doctor suggested she may be a candidate for a long acting injectable since she had been able to tolerate oral aripiprazole. Her doctor prescribed a long-acting treatment option called ARISTADA^® (aripiprazole lauroxil). ARISTADA is a prescription medicine given by injection by a healthcare professional and used to treat schizophrenia in adults. It is not known if ARISTADA is safe and effective in children under 18 years of age. It is important to know that elderly people with dementia-related psychosis are at increased risk of death when treated with antipsychotic medicines including ARISTADA. ARISTADA is not for the treatment of people who have lost touch with reality (psychosis) due to confusion and memory loss (dementia).² The most common side effect of ARISTADA includes restlessness or feeling like you need to move (akathisia). There are other side effects, some of them serious. Please see additional Important Safety Information below.

Kim now receives ARISTADA 882 mg every 6 weeks and it has worked well for her. Since receiving ARISTADA, Kim has experienced an improvement in her schizophrenia symptoms. It’s important to note that this is only Kim’s experience and the experiences and treatment responses of others may vary.

Kim and Ashley live about an hour apart, and prior to the pandemic, Ashley was driving to see her mother a few times each week. With Kim’s progress over the last year, and with the need for social distancing during the pandemic, Ashley has extended the time between visits and now sees her mother in person every 2 to 3 weeks, although they continue to stay in close touch with daily phone calls. She says that frequent communication with a loved one can make all the difference. She also makes time for her kids to talk with their grandmother on the phone as often as possible.

“While the pandemic has been challenging because we maintain our distance in an effort to keep ourselves healthy, we’ve learned that physical distance does not have to mean emotional distance,” Ashley said. “My mom knows that I’m always here for her—even if you can’t physically be with your loved one, you can be there emotionally, and that’s critical.”

Ashley and Kim have worked together to deal with new restrictions on in-person office visits. Heightened safety measures for in-person visits, home healthcare aides, a weekly therapist (via video conferencing) and telehealth services have enabled Kim to continue seeing her health care team and stay on track with treatment, despite navigating a global pandemic.

“As an adult, I’ve realized that mental health care takes a village. You have to be willing to do your part as a family member, but also advocate for your loved one and be open to helpful resources,” Ashley said.

During these uncertain times, if you or a loved one is struggling with mental health, there are numerous resources that may be helpful. Consider joining peer or social support groups that can encourage empathy, productive discussions and a sense of community.^3,4 Additionally, telepsychiatry platforms allow people to continue to engage in therapy/counseling while complying with social distancing guidelines.^5,6 Educational guides and resources are available online from several organizations, including Mental Health America (MHA), the Substance Abuse and Mental Health Services Administration (SAMHSA) or the National Alliance on Mental Illness (NAMI).⁷

Caring for someone living with serious mental illness can be especially difficult during this time of social distancing. But it is important to remember that you are not alone and there can be a lot to learn from others’ experiences to help ourselves and our loved ones.

This is intended as informational only and not a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical and/or mental health condition.

Please read the Important Safety Information for ARISTADA below. Discuss all benefits and risks with a healthcare provider. See Prescribing Information and Medication Guide.

INDICATION AND IMPORTANT SAFETY INFORMATION FOR ARISTADA INITIO AND ARISTADA⁸

INDICATION

ARISTADA INITIO^® (aripiprazole lauroxil) is a prescription medicine given as a one-time injection and is used in combination with oral aripiprazole to start ARISTADA^® (aripiprazole lauroxil) treatment, or re-start ARISTADA treatment after a missed dose, when ARISTADA is used for the treatment of schizophrenia in adults.

ARISTADA is a prescription medicine given by injection by a healthcare professional and used to treat schizophrenia in adults.

It is not known if ARISTADA INITIO and/or ARISTADA are safe and effective in children under 18 years of age.

IMPORTANT SAFETY INFORMATION

Contraindication: Do not receive ARISTADA INITIO or ARISTADA if you are allergic to aripiprazole or any of the ingredients in ARISTADA. Allergic reactions to aripiprazole have ranged from rash, hives and itching to anaphylaxis, which may include difficulty breathing, tightness in the chest, and swelling of the mouth, face, lips, or tongue.

ARISTADA INITIO and/or ARISTADA may cause serious side effects including:

• Cerebrovascular problems (including stroke) in elderly people with dementia- related psychosis that can lead to death.
• Neuroleptic malignant syndrome (NMS), a serious condition that can lead to death. Call your healthcare provider or go to the nearest hospital emergency room right away if you have some or all of the following signs and symptoms of NMS:
  • high fever
  • stiff muscles
  • confusion
  • sweating
  • changes in pulse, heart rate, and blood pressure
• Uncontrolled body movements (tardive dyskinesia). ARISTADA INITIO and ARISTADA may cause movements that you cannot control in your face, tongue, or other body parts. Tardive dyskinesia may not go away, even if you stop receiving ARISTADA. Tardive dyskinesia may also start after you stop receiving ARISTADA.
• Problems with your metabolism such as:
  • High blood sugar (hyperglycemia). Increases in blood sugar can happen in some people who receive ARISTADA INITIO and/or ARISTADA. Extremely high blood sugar can lead to coma or death. If you have diabetes or risk factors for diabetes (such as being overweight or a family history of diabetes), your healthcare provider should check your blood sugar before you receive ARISTADA INITIO and/or ARISTADA and during your treatment with ARISTADA.
    • Call your healthcare provider if you have any of these symptoms of high blood sugar:
      • feel very thirsty
      • need to urinate more than usual
      • feel very hungry
      • feel weak or tired
      • feel sick to your stomach
      • feel confused, or your breath smells fruity

• • Increased fat levels (cholesterol and triglycerides) in your blood
  • Weight gain. You and your healthcare provider should check your weight regularly.

• Unusual and uncontrollable (compulsive) urges. Some people taking aripiprazole have had strong unusual urges such as gambling that cannot be controlled (compulsive gambling). Other compulsive urges include sexual urges, shopping, and eating or binge eating. If you or your family members notice that you are having unusual strong urges, talk to your healthcare provider.
• Decreased blood pressure (orthostatic hypotension). You may feel lightheaded or faint when you rise too quickly from a sitting or lying position.
• Falls. ARISTADA INITIO and ARISTADA may make you sleepy or dizzy when standing which may make you at risk for falls and related injuries.
• Low white blood cell count
• Seizures (convulsions)
• Problems controlling your body temperature. Avoid becoming too hot or dehydrated. Do not exercise too much. In hot weather, stay inside in a cool place if possible. Stay out of the sun. Do not wear too much clothing or heavy clothing. Drink plenty of water.
• Difficulty swallowing

The most common side effects of ARISTADA INITIO and ARISTADA include restlessness or feeling like you need to move (akathisia). These are not all the possible side effects of ARISTADA INITIO and ARISTADA. You should tell your healthcare provider about any side- effects you have.

Do not drive, operate hazardous machinery, or do other dangerous activities until you know how ARISTADA INITIO and ARISTADA affect you. ARISTADA INITIO and ARISTADA may affect your judgment, thinking or motor skills.

Before receiving ARISTADA INITIO and ARISTADA tell your healthcare provider about all of your medical conditions, including if you:

• have not taken Abilify^®, Abilify Maintena^®, or any aripiprazole product before
• have or had heart problems or a stroke
• have diabetes or high blood sugar or a family history of diabetes or high blood sugar. Your healthcare provider should check your blood sugar before you receive ARISTADA INITIO and/or ARISTADA and during your treatment with ARISTADA
• have or had low or high blood pressure
• have or had seizures (convulsions)
• have or had a low white blood cell count
• have problems that may affect you receiving an injection in your buttocks or your arm
• are pregnant or plan to become pregnant. It is not known if ARISTADA INITIO and/or ARISTADA will harm your unborn baby. If you become pregnant while taking ARISTADA INITIO and/or ARISTADA, talk to your healthcare provider about registering with the National Pregnancy Registry for Atypical Antipsychotics. You can register by calling 1-866-961-2388, or visit http://womensmentalhealth.org/clinical-and- research-programs/pregnancyregistry/
• are breastfeeding or plan to breastfeed. ARISTADA INITIO and/or ARISTADA can pass into your breast milk. It is not known if it may harm your baby. Talk to your healthcare provider about the best way to feed your baby if you receive ARISTADA INITIO and/or ARISTADA.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. ARISTADA INITIO and ARISTADA and other medicines may affect each other causing possible serious side effects. Do not start or stop any medicines after you receive ARISTADA INITIO and ARISTADA without talking to your healthcare provider first.

If you have any questions about your health or medicines, talk to your healthcare provider. You are encouraged to report all side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

Please see full Prescribing Information for ARISTADA INITIO and ARISTADA, including Boxed Warning, and Medication Guides for ARISTADA INITIO and ARISTADA.

References

¹ Panchal, N., Kamal, R., K. O., C. C., Garfield, R., Hamel, L., . . . Chidambaram, P. The Implications of COVID-19 for Mental Health and Substance Use. Kaiser Family Foundation. https://www.kff.org/health-reform/issue-brief/the-implications-of-covid-19-for-mental-health-and-substance-use/ Published August 21, 2020. Accessed October 16, 2020

² Alkermes Inc. ARISTADA^® (Aripiprazole Lauroxil) [Prescribing Information]. Waltham, MA:2021.

³ Find Support Groups. Mental Health America. https://www.mhanational.org/find-support-groups. Published 2020. Accessed October 16, 2020

⁴ Support & Education: NAMI Connection. National Alliance on Mental Illness. https://www.nami.org/Support-Education/Support-Groups/NAMI-Connection. Published 2020. Accessed October 16, 2020

⁵ Serious mental illness and COVID-19: How to help your patients right now. American Psychological Association. https://www.apaservices.org/practice/legal/technology/serious-mental-illness-covid-19. Published May 1, 2020. Accessed October 16, 2020

⁶ Weigel G., Ramaswamy A., Sobel L., Salganicoff A., Cubanski J., & Freed M. Opportunities and Barriers for Telemedicine in the U.S. During the COVID-19 Emergency and Beyond. Kaiser Family Foundation. https://www.kff.org/womens-health-policy/issue-brief/opportunities-andbarriersfor-telemedicine-in-the-u-s-during-the-covid-19-emergency-and-beyond/. Published May 11, 2020. Accessed September 22, 2020

⁷ About Mental Illness Treatments. National Alliance on Mental Illness. https://www.nami.org/About-Mental-Illness/Treatments. Published 2020. Accessed October 16, 2020

⁸ Alkermes Inc. ARISTADA INITIO^® (Aripiprazole Lauroxil) [Prescribing Information]. Waltham, MA:2021.

ALKERMES^® is a registered trademark of Alkermes, Inc. ARISTADA is a registered trademark of Alkermes Pharma Ireland Limited, used by Alkermes, Inc. under license.

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