Clinical and psychosocial deterioration associated with schizophrenia occurs within the first few years following the onset of the illness. Therefore, to improve the long-term prognosis, it is important to provide schizophrenia patients with intensive treatment following their first episode. Relapse is highly associated with partial medication adherence or nonadherence in patients with first-episode schizophrenia. Recent studies suggest that long-acting injectable (LAI) antipsychotics compared with oral antipsychotics are more effective for medication adherence and relapse prevention. Moreover, some clinical guidelines for the treatment of schizophrenia suggested that LAI antipsychotics should be considered when patients are nonadherent “at any stage.” Decreased compliance is a common cause of relapse during the initial stages of the disease. Therefore, LAI antipsychotics should be highly considered when treating patients with first-episode schizophrenia. In the present paper, clinical trial data and current guidelines on the use of LAI antipsychotics for first-episode schizophrenia are discussed as well as the pros and cons of this treatment option. 1. Introduction Schizophrenia is a chronic disorder characterized by periods of illness alternating with periods of full or partial remission. Previous studies [1, 2] suggest that schizophrenia is a neurodegenerative disease associated with frequent relapses. This alternating nature of the illness causes neurotoxicity in the brain, thereby resulting in structural abnormalities, including ventricular enlargement and cortical atrophy. Recent evidence further suggests that progressive structural changes in the brain occur within the initial years following a diagnosis [3–5]. Moreover, with each subsequent relapse after the first episode, it usually takes longer time to reach remission [6]. The primary clinical and psychosocial deterioration associated with schizophrenia occurs within the first 5 years following the onset of the illness, called the critical period [7, 8]. Therefore, it is important to provide intensive biopsychosocial interventions during the critical period in an effort to improve the long-term prognosis. The primary goal of treatment during the critical period is to prevent a subsequent relapse and to restore socio-occupational functioning to the premorbid level. The relapse rate in patients with first-episode schizophrenia is relatively low during the first year of the illness but substantially rises to rates of 53.7% and 74%–81.9% after 2 and 5 years, respectively [9, 10]. The most common
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