Leveraging Novel Delivery Systems to Optimize Inpatient to Community Transitions in Schizophrenia

In this episode, "Leveraging Novel Delivery Systems to Optimize Inpatient to Community Transitions in Schizophrenia," the expert psychiatrist Dr. Christoph Correll explores the expanding landscape of novel delivery systems and mechanisms of action that hold promise for improving the often precarious transition from acute inpatient care to the community setting.

Dr. Correll opens by surveying several emerging options relevant to acute and transitional care. He highlights sublingual dexmedetomidine — a recently approved alpha-2 agonist that modulates the noradrenergic system to reduce acute agitation — as well as intranasal olanzapine, currently under investigation as a rapid-acting alternative to injections that could serve as a bridge to outpatient therapy. He also discusses the potential of olanzapine-samidorphan as a strategy to maintain the efficacy of olanzapine while meaningfully reducing long-term weight gain, and notes the interest in introducing muscarinic modulators early in the inpatient course, though formulary barriers and cost currently limit their uptake in that setting.

A central focus of the discussion is the emergence of subcutaneous long-acting injectable formulations, particularly subcutaneous risperidone and an investigational subcutaneous olanzapine. Dr. Correll explains that these agents build therapeutic blood levels within a day, eliminating the need for oral overlap or booster injections and — in the case of subcutaneous olanzapine — removing the risk of post-injection delirium sedation syndrome associated with the deep intramuscular formulation. This safety profile removes the requirement for three-hour post-injection observation and the need for intubation availability, significantly reducing the logistical burden of administration in outpatient settings.

Dr. Correll closes by underscoring the urgency of addressing the post-discharge medication gap, citing Finnish data showing that approximately half of early-phase patients did not fill their next prescription within 30 days of discharge. He argues that deploying long-acting injectables during inpatient stays — particularly those that rapidly establish therapeutic levels — represents a high-value intervention that can preserve the gains achieved during hospitalization, reduce readmission rates, and ultimately deliver meaningful cost savings within a value-based care framework.

The last episode in this series, "Optimizing Long-Term Outcomes in Community-Based Schizophrenia Care," features the panelists reflecting on strategies for sustaining schizophrenia care across the community continuum, and sharing their closing perspectives on the single most impactful systemic change they would make to improve how schizophrenia is managed in the United States.