Approximately 80% of patients with the first-episode schizophrenia reach symptomatic remission after antipsychotic therapy. However, within two years most of them relapse, mainly due to low levels of insight into the illness and nonadherence to their oral medication. Therefore, although the formal data available is limited, many experts recommend prescribing long-acting injectable second-generation antipsychotics (mostly risperidone or alternatively paliperidone) in the early stages of schizophrenia, particularly in patients who have benefited from the original oral molecule in the past and agree to receive long-term injectable treatment. Early application of long-acting injectable second-generation antipsychotics can significantly reduce the risk of relapse in the future and thus improve not only the social and working potential of patients with schizophrenia but also their quality of life. 1. Depot Antipsychotics for the Treatment of Schizophrenia First-generation long-acting injectable (depot) antipsychotics (AP1G) emerged in clinical practice in the 1960s. For the treatment of schizophrenia, their use resulted in a significant decrease in the number of patients relapses, including length and frequency of hospitalizations [1]. However, when oral second-generation antipsychotics (AP2G) were introduced thirty years later, the position (in clinical practice) of depot AP1G dramatically changed. Despite the benefits of AP1G, psychiatrists prescribed them for long-term therapy of schizophrenia much less often and started to switch to oral AP2G as they were seen as more efficient and better tolerated [2]. This trend persisted for many years, despite evidence to suggest from meta-analyses and naturalistic studies that depot AP1G were more effective in reducing schizophrenic relapses than oral AP2G [3]. The same finding was later logically replicated also for long-acting injectable (LAI) AP2G [4–7]. Although patients with schizophrenia are often willing to use depot or LAI antipsychotics, these preparations are today prescribed only for approximately 20% of them [8–10]. In a survey [11] psychiatrists answered that they only offer long-acting injectable antipsychotics to one in every three patients with schizophrenia. 2. Specifics for First-Episode Schizophrenia Therapy Therapy for the first episode of schizophrenia has certain specific features. Patients respond to low doses of antipsychotics relatively well; yet they are more sensitive to the adverse effects, particularly extrapyramidal ones [12, 13]. Patients with first-episode schizophrenia, however,
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