Long-acting drugs lead to better outcomes for schizophrenics

Patients with a first episode of psychosis should be offered an injection of a long-acting antipsychotic rather than just oral medication. In the image, a sad, depressed man and his reflection — Schizophrenics have fewer relapses and better control of symptoms like hallucinations when given long-acting antipsychotic injections compared with oral medication

Non-adherence to oral antipsychotic medication is common among people with schizophrenia and is associated with the return of symptoms. Long-acting injectable antipsychotics offer the potential of improved adherence and clinical outcomes but are rarely used in patients with first-episode psychosis.

Now, a randomised clinical trial involving 86 patients with a first schizophrenia episode has shown that treatment with the long-acting injectable risperidone is associated with a significantly lower rate of psychotic exacerbations or relapses than oral risperidone (5% versus 33%; P<0.001). The injectable formulation is also associated with better adherence and greater control of psychotic symptoms such as hallucinations.

These “notable advantages” presumably reflect the more consistent administration of the long-acting drug, say the researchers in JAMA Psychiatry (online, 24 June 2015)^[1]. The team conclude that such formulations should be offered earlier in the course of illness.