Reframing Long-Acting Injectable Antipsychotics as a Path to Patient Autonomy

CONFERENCE REPORTER

At the 2026 Jersey City Psychiatry Conference, event chair Christoph U. Correll, MD, professor of psychiatry and molecular medicine at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and professor and chair of the Department of Child and Adolescent Psychiatry at Charité Universitätsmedizin Berlin, spoke about why long-acting injectable (LAI) antipsychotics remain underused in schizophrenia despite strong evidence behind them.

Across randomized trials, cohort studies, and meta-analyses, LAIs have outperformed oral antipsychotics in preventing relapse and hospitalization.¹ Correll said the benefit comes from better adherence and from making nonadherence visible. Patients who stay stable can then function better and work toward their own goals.

Barriers on the Prescriber Side

Correll said clinicians may hesitate because they are uncomfortable with needles or with giving injections. Some also worry that offering an LAI tells the patient they are not trusted or takes away their autonomy.

"We need to turn that around. We're giving patients autonomy by having them function better and not have to be ambivalent every day," Correll said.

He added that the daily question of whether to take a medication can spill over into conflict with family members and professional caregivers, who may struggle to know whether doses were taken. An LAI can ease that tension.

Correll also addressed the fear that an LAI cannot be adjusted once it is given. He said clinicians should establish the effective dose before starting the injectable. Tolerability may also be somewhat better with LAIs because they produce less peak-trough variation than oral dosing.²

Wide Variation in Use

In the United States, the share of patients with schizophrenia receiving an LAI ranges from under 5% to 22%, depending on the state. "The patients are the same," Correll said. The difference, he said, lies with prescribers: whether they feel comfortable offering the choice and following through with psychoeducation.

Dr Correll is professor at the Institute of Behavioral Science, Feinstein Institutes for Medical Research; medical director of the Recognition and Prevention Program in the Department of Psychiatry at Zucker Hillside Hospital; and professor of Psychiatry and Molecular Medicine at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell.

References

1. Kishimoto T, Hagi K, Kurokawa S, et al. Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia: a systematic review and comparative meta-analysis of randomised, cohort, and pre-post studies. Lancet Psychiatry. 2021;8(5):387-404.

2. Correll CU, Citrome L, Haddad PM, et al. The use of long-acting injectable antipsychotics in schizophrenia: evaluating the evidence. J Clin Psychiatry. 2016;77(suppl 3):1-24.