Concurrent use of two long-acting injectable (LAI) antipsychotics in forensic patients with treatment-resistant...

ObjectiveDescribe concurrent use of two long-acting injectable (LAI) antipsychotics in selected patients with treatment-resistant schizophrenia and persistent aggression at a forensic health facility. Evidence remains limited for this off-licence strategy.MethodsRetrospective case series conducted at a specialist forensic psychiatric hospital in Melbourne, Australia. All inpatients using concurrent LAI antipsychotics between March 2022 and March 2023 were included (N = 26). De-identified clinical data, including information for behavioral outcomes (Dynamic Appraisal of Situational Aggression [DASA]), institutional incidents, adverse effects and Defined Daily Dose (DDD) were extracted. Analyses were descriptive with exploratory unadjusted odds ratios.ResultsConcurrent LAI antipsychotics were predominantly prescribed to males (24/26, 92.3%) with chronic schizophrenia. Persistent aggression (22/26, 84.6%) was the commonest indication. Most frequent combination was olanzapine pamoate and zuclopenthixol decanoate and DDD median was 2.17 (range 0.48-10.13). Although the study design precluded identifying causal relationships, improvements were observed in DASA scores (21/26, 80.8%), incident frequency (22/26, 84.6%), and as-required-medication use (19/26, 73.1%). Adverse effects were common.ConclusionsSelected forensic patients with high-risk behaviors may benefit from concurrent LAI antipsychotics. Enhanced side-effect monitoring and multidisciplinary oversight are required when used. Data interpretation was limited by observational design, concomitant medications, and absence of standardized symptom measures.