Improving Outcomes in Schizophrenia With Long-Acting Injectables: Insights from the Southern Florida Psychiatry Conference

CONFERENCE REPORTER

Patricia Junquera, MD, Maria Collado, MD, and Erin Crown, MHS, PA-C, discussed best practices for use of long-acting injectables (LAIs) at the Southern Florida Psychiatry Conference in West Palm Beach, Florida.¹ The presentation covered benefits of LAIs in treatment of schizophrenia, focusing on how they can improve patient outcomes and reduce risk of relapse.

LAI administration can enable providers to confirm that the entire medication dose is being received, rather than patients potentially missing doses with a daily pill regimen. “The key is the freedom of having that patient think about mediation once a month vs every day, twice a day,” Collado said. Junquera emphasized that LAIs can be useful earlier on in a patient’s illness—for patients to be able to stay stable before they can reach a point of decline due to medication noncompliance. With noncompliance, the risk of substance use disorder and relapse increases significantly, and an LAI may be right for the patient to prevent them from getting to the point of relapse.² Using LAIs earlier can provide a very significant reduction is likelihood of relapse, rehospitalization, and cognitive symptoms.

For LAIs with longer intervals between doses, patients do not need to be concerned with keeping up with medication; better outcomes, adherence, and convenience may come with this option. Collado cited research that LAIs can lower the stress and worry for patients and providers about medication adherence. Providers know the patient is receiving their medication because of the supervised injection, and they can turn to other causes beyond nonadherence if an issue arises for the patient.

The way that providers present LAIs to patients can also affect their willingness to engage in this type of treatment. Collado pointed out that other specialties with medications like birth control and preexposure prophylaxis also use LAIs but face less stigma than psychiatric LAIs tend to. Having a strong therapeutic alliance and connection with the patient is essential in beginning LAIs.

Collado discussed the mechanism of LAIs, noting that half-lives are important considerations in beginning this type of medication. When LAIs are being administered consistently, “you are getting a more consistent and predictable blood level [of the drug] for your patient,” Collado said. Considering different medications in their LAI form, it is important to note whether loading doses, multiple injections, or potentially oral supplementation may be helpful. Because of the intramuscular administration of LAIs, the concentration curve is unique, and the drug is dispersed quite differently than an oral route.

Crown moved into discussing different types of LAIs and how different drugs may require different starting strategies. Considering the timing of the peak concentration of the LAI is also useful in emergency settings. Different options are available for loading doses and maintenance doses, but depending on the medication, total dosage should be kept in mind so as not to administer too much at once and potentially have adverse effects like involuntary movement, Crown pointed out. The variety of medications and administration intervals available in LAI form can provide more flexibility for both patients and providers.

References

1. Junquera P, Collado M, Crown E. Overcoming Barriers to Use of Long-Acting Injectable Agents in Schizophrenia. Conference Proceedings of the Southern Florida Psychiatry Conference. November 2025;21-22. West Palm Beach, FL.

2. Kishimoto T, Robenzadeh A, Leucht C, et al. Long-acting injectable vs oral antipsychotics for relapse prevention in schizophrenia: a meta-analysis of randomized trials. Schizophr Bull. 2014;40(1):192-213.