Schizophrenia is a chronic, debilitating, neurodegenerative, and progressive disease that affects all aspects of the patient’s life (personal, social, vocational, and spiritual). The longer the duration of untreated psychosis, the higher the chances of poorer outcomes such as more severe negative and positive symptoms, reduced overall functioning, quality of life, and reduced global cognition (1). Hence, early detection of psychosis may increase the chance of recovery and improve functional outcomes. In patients whose psychosis was detected earlier, significantly more patients recovered, had full-time work, and had weekly contact with friends (2). Patients early in the course of schizophrenia indicate that symptom- and functioning-related goals as their most important treatment goals (3).

Nevertheless, poor adherence to treatment remains a recognized problem in the management of patients with schizophrenia. Multiple factors have been identified as increasing the risk of non-adherence, including complex medicines schedules. In a meta-analysis, medication non-adherence increased the risk of relapse after a first psychotic episode by 4 folds (4).

Extensive evidence demonstrates the benefits of long-acting injectable (LAI) antipsychotics in lowering the risk of relapse and hospitalization, and in improving adherence compared to oral antipsychotics (5,6). Despite this, LAI antipsychotics are still underutilized in newly diagnosed patients with schizophrenia. In a US-based, real-world study, only 4.4% of young adults with a first episode of schizophrenia were treated with a second-generation LAI (7).

Underutilization of LAIs in early-phase schizophrenia can be attributed to several factors, including clinicians’ overestimation of patient adherence, biases against injections, and concerns that discussing LAIs may require excessive time or imply a lack of trust, thus straining the therapeutic alliance. Challenges in interpreting the mixed results of research studies assessing the benefits of LAIs, limited clinician training on LAI administration and management, and insufficient focus on shared decision-making also contribute. Additionally, some guidelines recommend LAIs only as a last-resort option, and the involvement of family members or peer counselors is often overlooked (7). To address these barriers, shared decision-making should be prioritized, and training should focus on the importance of adherence in preventing relapse, LAI benefits for early-phase schizophrenia, and effective LAI implementation strategies. Role-playing scenarios can be used to better equip clinical teams and foster open, supportive conversations about LAIs for first-episode psychosis and early-phase schizophrenia.