Risperidone long-acting injection in the treatment of first episode schizophrenia

Pharmacological treatments of first episode schizophrenia are of particular relevance because most clinical and psychosocial deterioration with cognitive decline and changes in brain volume occurs in the first five years of disease onset. Although the efficacy of antipsychotic maintenance treatment has been demonstrated to reduce risk of relapse, nonadherence is common even in first episode schizophrenia patients. Antipsychotic long-acting injections (LAIs) could be an option in early treatment although international guidelines recommend their use in patients who have already experienced significant non-adherence and who have repeated relapse. At the present time there is some concern about the acceptability of LAIs in first episode schizophrenia: some studies suggest that LAI treatment is feasible in these patients because of distinct advantages in terms of better treatment adherence. In the present review, we analyze the few currently studies published on the use of risperidone long-acting injection (RLAI) to improve adherence in first episode schizophrenia. Further research is needed to support the routine use of LAIs and of the other second generation antipsychotic LAIs (olanzapine long-acting and paliperidone palmitato) in this population of patients to improve adherence.