Schizophrenia Practice Guidelines Mostly Recommend Long-Acting Injectable Antipsychotics During First Episode

Recommendations for pharmacotherapy with antipsychotics as both acute and maintenance treatment of schizophrenia were made following a systematic literature review of current clinical practice guidelines.

Clinical practice guidelines are now largely recommending the use of long-acting injectable (LAI) antipsychotics during the first episode of schizophrenia, as well as more broadly across the illness trajectory with only a single guideline recommending LAI antipsychotics independent of treatment adherence status, according to study results presented at Psych Congress 2020, held virtually from September 10 to 13, 2020.

Researchers conducted a systematic review of schizophrenia clinical practice guidelines published between 2014 and 2019 in MEDLINE an Embase, and on the websites of guideline organizations. A total of 19 clinical practice guidelines on the treatment of schizophrenia were identified and included 7 guidelines from the United States, 3 from the United Kingdom, 3 international guidelines, and 1 each from Australia/New Zealand, Canada, France, Italy, Poland, and Singapore.

All guidelines, aside from one from Italy, referenced the use of LAI antipsychotics for managing schizophrenia. The majority (74%) of practice guidelines recommended the use of LAI antipsychotics in patients who are nonadherent to treatment. Additionally, 12 (63%) guidelines cited patient preference as a reason to consider LAI antipsychotics. A total of 13 (68%) guidelines recommended LAI antipsychotics as maintenance therapy. The Florida Medicaid Program practice guideline was the only guideline that recommended LAI antipsychotics as the first step, independent of adherence status, after initial response to oral antipsychotics. A total of 5 (26%) practice guidelines recommended the use of LAI antipsychotics across the entire course of illness, beginning with the first episode of schizophrenia.

A limitation of this study was the inclusion of guidelines published during varying years, which the investigators suggest limited “the identification of areas of consensus and disagreement” in schizophrenia management. Additionally, the guidelines included in this review did not provide information on recommendations to clinicians about how to discuss the use of LAI antipsychotics with their patients and/or family members.

Disclosure: This clinical trial was supported by Janssen. Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Correll C, Martin A, Patel C, et al. A systematic literature review of schizophrenia clinical practice guidelines: recommendations on use of long-acting injectable antipsychotic medications. Presented at: Psych Congress 2020 Virtual Experience; September 10-13, 2020. Poster 103.