Introduction: Antipsychotic medications are effective for people living with schizophrenia, but long-term treatment adherence remains challenging, leading to relapses and poor outcomes. Long-acting injectable antipsychotics (LAIs) may improve adherence and reduce relapses compared with oral antipsychotics. Barriers to the use of LAIs exist, yet practical recommendations to overcome them are lacking. Therefore, an expert consensus panel was formed to develop key recommendations using a modified Delphi panel method.
Methods: The panel chair and Interactive Forums, Inc., conducted a narrative literature review of English-language articles published in the 10 years before 02/02/2024. Panelists rated, discussed, and re-rated proposed statements during 2 online premeetings and 2 virtual group meetings in 2024. Consensus was defined as ≥ 75% agreement.
Results: The consensus panel initially included 9 experts and was expanded to 12, representing 6 countries and diverse psychiatric and lived experiences. In the first round, 31 recommendations were developed, with a high level of agreement; these were refined to 26 statements in the second round. Recommendations covered: (1) overcoming barriers to LAI initiation and use for the treatment of people with schizophrenia, and (2) procedures for initiation and switching, monitoring, and maintenance of LAIs for people with schizophrenia. The panel recommended that healthcare professionals (HCPs) consider LAIs proactively and initiate them early after a confirmed schizophrenia diagnosis. The importance of continued treatment with LAIs and their role in assessing nonadherence and treatment resistance were also highlighted. Further, the panel recommended that HCPs evaluate any personal biases about LAIs and engage in training/education to support goal setting and shared decision-making with patients and caregivers. Guidance on switching between antipsychotic formulations and maintaining treatment was also provided.
Conclusions: This expert consensus panel provided recommendations to guide HCPs on how to overcome barriers to LAI use and to implement, monitor, and maintain LAIs as routine schizophrenia treatment.
Keywords: Expert consensus; Long-acting injectable antipsychotics; Schizophrenia.
Antipsychotic medicines can work well for people living with schizophrenia, but some struggle to take their pills every day. Antipsychotic medicines that are injected and can be given once every 2 weeks or once every 2-, 3-, or 6-months work for a long time and can help these people; however, there are some problems that prevent patients from getting these injectable antipsychotics. A group of experienced doctors came together to give suggestions that other doctors can use to successfully offer injectable antipsychotics to their patients. The group had 2 meetings to work on the suggestions. The experts advised that the injectable antipsychotics should be given to patients as early as possible. Once people living with schizophrenia start taking the injectable antipsychotics, they should take them for as long as possible to stay healthy. These medicines are given by a healthcare professional, which makes them easier to use because doctors and caregivers know when patients miss an injection and can help them remember to get the injection. Injectable antipsychotics can also help doctors know if the medicines do not work for some patients. Doctors, nurses, patients, and caregivers all need good training to help them decide which long-acting injectable antipsychotic to use. The suggestions from the expert doctors will teach other doctors how to switch patients from antipsychotic pills to an injectable antipsychotic or from one injectable antipsychotic to another. They will also help doctors learn how to keep patients who are taking these medicines healthy for longer.
© 2025. The Author(s).