Compared to oral antipsychotics, LAIs are highly effective in preventing a second episode of psychosis (see reference). Achieving sustained remission is a critical treatment goal for first-episode psychosis patients who are trying to put their lives together after their first episode (e.g., finishing school).
Prior to initiating any LAI, tolerability needs to be established with the oral version of the antipsychotics; see this tip for more information. LAIs cannot be given to antipsychotic-naïve patients. This is not a clinical problem as the initial stabilization of first-episode patients is often better done with oral medications due to more flexibility and easier dose adjustments. The treatment plan can then anticipate a switch to a LAI as soon as is feasible.
Clinicians who want to use LAIs in first-episode patients should do the following:
Subotnik KL, Casaus LR, Ventura J, Luo JS, Hellemann GS, Gretchen-Doorly D, et al. Long-acting injectable risperidone for relapse prevention and control of breakthrough symptoms after a recent first episode of schizophrenia. A randomized clinical trial. JAMA Psychiatry. 2015;72(8):822-829.
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