Functional remission following early initiation of long-acting injectable paliperidone in a young professional athlete with schizophrenia: a case report

Functional remission following early initiation of long-acting injectable paliperidone in a young professional athlete with schizophrenia: a case report

Background: Schizophrenia is a chronic psychiatric disorder marked by recurrent relapses, frequently driven by poor adherence to oral antipsychotic treatment, particularly in younger patients. Repeated exacerbations are associated with cumulative functional decline and disruption of educational and occupational trajectories. Long-acting injectable (LAI) antipsychotics are an evidence-based strategy to improve adherence and reduce relapse risk; however, they remain underutilized in early stages of illness, especially in patients with high functional demands.

Case Presentation: We present a 23-year-old male professional football player diagnosed with schizophrenia (ICD-10: F20.8), with comorbid neurodevelopmental features (F84.0), and illness onset in 2018. His clinical course was characterized by persistent non-adherence to oral antipsychotic treatment, resulting in five (5) psychiatric hospitalizations and progressive psychosocial deterioration.

Prior to Long acting injectables initiation, the patient exhibited a severe clinical picture dominated by negative symptoms (avolition, anhedonia, abulia), behavioral disorganization, marked self-neglect, social withdrawal, reduced frustration tolerance, and suspected perceptual disturbances, accompanied by global functional impairment and complete occupational disengagement. Insight and illness awareness were markedly impaired.

Given the clear pattern of relapse associated with non-adherence, treatment with paliperidone palmitate of 100mg as long acting injectable was initiated using a standard loading regimen, followed by maintenance with the 1-month formulation. After 4 months of stabilization with once per month formulation, the patient was transitioned to the 3-month formulation with dosage of 350mg. Treatment adherence was optimal, with 100% injection adherence and no missed doses, and tolerability was favorable.

Results: A marked and sustained clinical improvement was observed over the follow-up period, with no subsequent hospitalizations. Symptom trajectory, estimated using PANSS, demonstrated a reduction from approximately 95–105 at baseline to 65–70 after 3 months, and further to 40–50 following transition to the 3-month formulation.

Importantly, functional gains exceeded symptomatic improvement. Clinical stabilization was accompanied by functional remission, reflected in progressive reintegration into daily structure, restoration of self-care, and near-complete occupational restoration, with the patient successfully resuming professional-level training and competitive participation with satisfactory results.

Discussion: This case highlights the central role of adherence in determining clinical and functional outcomes in schizophrenia and supports the early use of long acting injectables antipsychotics in patients with recurrent relapses due to non-adherence. In contrast to traditional approaches reserving LAIs for chronic or treatment-resistant cases, this report underscores their value in early-course illness, particularly in individuals with high functional demands.

The observed dissociation between symptom reduction and functional recovery suggests that sustained treatment continuity may facilitate broader psychosocial stabilization beyond core psychopathology.

Conclusion: Early initiation of Long acting injectables paliperidone in young patients with schizophrenia and documented non-adherence may significantly reduce relapse burden and enable functional remission, including return to high-level occupational performance as a professional athlete.

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