Long-Acting Injectable Atypical Antipsychotic Use in Adolescents: An Observational Study

J Child Adolesc Psychopharmacol. 2018 May;28(4):252-257. doi: 10.1089/cap.2017.0096. Epub 2018 Jan 30.


Objectives: Although second generation long-acting injectable antipsychotics (SG-LAIAs) have been approved and are widely used in adults, there is limited evidence for the use of long-acting formulations in children and adolescents. Thus, we systematically describe the off-label use of SG-LAIAs in clinical practice in adolescent inpatients.

Methods: All individuals admitted to our Children and Adolescent Inpatient Psychiatry Unit receiving treatment with SG-LAIAs between January 2013 and June 2016 were reviewed. A retrospective analysis of medical records was conducted. Clinical diagnoses were established using DSM-5 criteria.

Results: Thirty individuals (53.3% female) out of a total of 1,148 admitted patients (2.6%) were identified. The mean age was 16.3 (SD = 1.3; range: 12.5-17.9).The main diagnoses were psychosis (70%) and disruptive behavior disorders (DBDs) (30%), although comorbidity was frequent (96.6%), especially drug use (55.2%, mostly cannabis). SG-LAIAs used were aripiprazole (40%), risperidone (36.7%), and paliperidone palmitate (23.3%), and the main reasons were a history of low compliance (90%) and/or poor insight (73.3%). A mean improvement of 31.7 (SD = 8.7) between admission and discharge was registered in the Children's Global Assessment Scale (CGAS); no differences were observed between different SG-LAIAs. Although they were generally well tolerated, 23.3% of patients reported mild short-term side effects, which were more frequent with risperidone than with aripiprazole (p = .014).

Conclusions: Our clinical experience suggests that SG-LAIAs may be a safe treatment option during adolescence in inpatients with psychotic disorders, as well as with DBD. No differences were found in CGAS improvement scores between the three SGA-LAIAs used, although patients on risperidone reported more side effects than those on aripiprazole. Further research is needed so as to evaluate safety and effectiveness of SG-LAIAs in this population.

Keywords: adolescent psychiatry; long-acting injectable antipsychotics; psychotic disorders; treatment efficacy.

Publication types

  • Comparative Study
  • Observational Study

MeSH terms

  • Adolescent
  • Antipsychotic Agents / adverse effects
  • Antipsychotic Agents / therapeutic use*
  • Aripiprazole / adverse effects
  • Aripiprazole / therapeutic use
  • Attention Deficit and Disruptive Behavior Disorders / drug therapy*
  • Child
  • Delayed-Action Preparations
  • Female
  • Hospitalization
  • Humans
  • Inpatients
  • Male
  • Off-Label Use
  • Paliperidone Palmitate / adverse effects
  • Paliperidone Palmitate / therapeutic use
  • Psychiatric Status Rating Scales
  • Psychotic Disorders / drug therapy*
  • Psychotic Disorders / physiopathology
  • Retrospective Studies
  • Risperidone / adverse effects
  • Risperidone / therapeutic use
  • Treatment Outcome


  • Antipsychotic Agents
  • Delayed-Action Preparations
  • Aripiprazole
  • Risperidone
  • Paliperidone Palmitate