Long-Acting Injectable Antipsychotics and Time to Readmission in Early Psychosis

Long-acting injectable (LAI) antipsychotics have demonstrated benefits in reducing relapse and hospitalization in psychotic disorders, yet their real-world impact in early-phase psychosis remains incompletely understood. This study examined baseline characteristics, hospitalization features, and postdischarge outcomes among young patients with early psychosis treated with LAI versus oral (PO) antipsychotics.

This retrospective chart review included 229 patients under age 25 hospitalized for psychosis at a multicenter health system between 2018 and 2022. Patients receiving LAI (N = 144) were compared with those receiving PO antipsychotics (N = 85) on sociodemographic, clinical, and admission variables. The primary outcome was psychiatric readmission within 1 year of discharge. Secondary outcomes included time to readmission, which was analyzed using Kaplan-Meier survival analysis. Multivariable logistic regression evaluated whether LAI treatment independently predicted readmission after adjusting for length of stay, prior hospitalizations, and undomiciled status.

The LAI group was older and exhibited greater clinical and social risk, including more prior hospitalizations, higher rates of undomiciled status, and more suicide attempts. They also had longer inpatient stays and greater medication complexity during hospitalization. One-year readmission rates were similar between groups (30.6% LAI vs. 24.7% PO). Among readmitted patients, the LAI group showed longer time to readmission. In adjusted analyses, LAI treatment was not independently associated with readmission. Undomiciled status was independently associated with readmission, paradoxically in the direction of lower odds.

For young patients with early psychosis, LAIs were preferentially prescribed to higher-risk patients but were not independently associated with reduced 1-year readmission. Comparable outcomes between groups despite greater baseline risk in the LAI cohort suggest that LAIs may partially mitigate elevated risk, though this interpretation requires prospective confirmation. Housing instability emerged as a critical determinant of readmission patterns, underscoring the need for integrated pharmacologic and social interventions in this population.