2026 ECNP Congress

EP02-2057

Are 3 days enough? Clinical decompensation following minor delays in long-acting injectable risperidone administration

Ioana Banu — M.I.C. Corban, L. Ovidiu, G.M. Stanciu · Spitalul Clinic de Psihiatrie Prof. Dr Alexandru Obregia, Secția 11, București, Romania

2026 ECNP Congress

INTRODUCTION

​Schizophrenia is a common severe mental disorder which is mainly manifested in the disorder of mental and psychological processes and has the characteristic of high disability rate and prolonged course. [1]

​Long-acting injectable (LAI) antipsychotics are associated with improved adherence and reduced relapse risk in schizophrenia. The clinical effectiveness of LAI antipsychotics depends on maintaining consistent dosing intervals, as fluctuations in drug administration may increase relapse risk. [2]

OBJECTIVES

​We present the case of a patient with schizophrenia whose symptomatology exhibited a marked exacerbation in the context of repeated delay in the administration of Risperidone LAI. Our purpose is to emphasize the necessity of continuous research and a better understanding of the clinical consequences on inconsistent administration of LAI, highlighting its role in symptoms exacerbation and relapse in patients with schizophrenia.

METHODS

We used structured and semi-structured psychiatric assessments to evaluate the patient’s symptoms and their evolution over time and exclude other possible causes that could have triggered the relapse.

RESULTS

A 62-year-old patient with schizophrenia had been receivingRisperidone LAI, titrated from 25 mg to 50 mg every 14 days, achieving initial clinical stability. Recurrent delays of 2–3 days in injection timing were observed when treatment was administered outside the hospital setting. These delays were followed by symptom exacerbation, predominantly characterized by psychotic anxiety and polymorphic delusional ideation, requiring hospitalization, with a PANSS score of 127 at admission. No other precipitating factors were identified. Notably, reflecting a good therapeutic alliance, the patient presented voluntarily to the hospital at symptom exacerbation, accompanied by family members. After re-establishing regular dosing intervals, along with temporary oral risperidone supplementation, clinical improvement was observed, with a PANSS score of 93 at discharge.

DISCUSSIONS

The LAI formulation of Risperidone shows a delayed release profile, with the main drug release occurring 2–3 weeks after administration and steady-state concentrations reached after 6–8 weeks of repeated dosing [3]. Maintaining a consistent schedulefor LAI antipsychotics is essential, as missed doses are commonand may compromise treatment outcomes; therefore, proactive strategies such as reminder systems, caregiver involvement, and prompt follow-up are recommended to improve adherence and ensure timely administration [4]. Management of missed doses of Risperidone LAI depends on whether steady state has been achieved and the time since the last dose; in general, the next injection should be administered as soon as possible, with oral antipsychotic supplementation required in cases of delayed dosingor when steady state has not yet been reached [5].

CONCLUSIONS

Even minor delays in LAI antipsychotic administration may impact clinical stability. Psychoeducation aimed at improving insight, together with strong family support, plays a key role in optimizing adherence. In addition, the implementation of proactive strategies (such as reminder systems, caregiver involvement, and structured follow-up) should be encouraged to ensure timely administration and reduce relapse risk. The use of longer-interval LAI formulations may further support treatment continuity and improve clinical outcomes.

References

  1. Guo J, Lv X, Liu Y, Kong L, Qu H, Yue W. Influencing factors of medication adherence in schizophrenic patients: a meta-analysis. Schizophr (Heidelb). 2023;9:31. doi:10.1038/s41537-023-00356-x
  2. Correll CU, Rubio JM, Kane JM. What is the risk–benefit profile of long-acting injectable antipsychotics? World Psychiatry. 2021;20(2):255–257
  3. Knox ED, Stimmel GL. Clinical review of a long-acting, injectable formulation of risperidone. Clin Ther. 2004;26(12):1994–2002.
  4. Saklad SR. Solutions to common issues in the use of LAIs. CNS Spectr. 2025;30(S1):S45–S50.
  5. Carpenter J, Wong KK. Long-acting injectable antipsychotics: what to do about missed doses. Curr Psychiatry. 2018;17(7):11–19.