Clin Psychopharmacol Neurosci.  2015 Aug;13(2):121-128. 10.9758/cpn.2015.13.2.121.

A Systemic Review and Experts' Consensus for Long-acting Injectable Antipsychotics in Bipolar Disorder

  • 1Department of Psychiatry, Taipei Veterans General Hospital & National Yang Ming University, Taipei, Taiwan.
  • 2Department of Psychiatry, Chung Shan Medical University Hospital, Taichung, Taiwan.
  • 3School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
  • 4Department of Psychiatry, Wei-Gong Memorial Hospital, Miaoli, Taiwan.
  • 5Department of General Psychiatry, Taoyuan Psychiatric Center, Ministry of Health and Welfare, Taoyuan, Taiwan.
  • 6Department of Psychiatry, Tainan Municipal Hospital, Tainan, Taiwan.
  • 7Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan.
  • 8Department of Psychiatry, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan.
  • 9Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan.
  • 10Department of Psychiatry, Cardinal Tien Hospital, Taipei, Taiwan.
  • 11Department of Psychiatry, Taipei Veterans General Hospital, aohsiung, Taiwan.
  • 12Department of Psychiatry, E-Da Hospital, Kaohsiung, Taiwan.


Bipolar disorder (BD) is a major psychiatric disorder that is easily misdiagnosed. Patient adherence to a treatment regimen is of utmost importance for successful outcomes in BD. Several trials of antipsychotics suggested that depot antipsychotics, including long-acting first- and second-generation agents, are effective in preventing non-adherence, partial adherence, and in reducing relapse in BD. Various long-acting injectable (LAI) antipsychotics are available, including fluphenazine decanoate, haloperidol decanoate, olanzapine pamoate, risperidone microspheres, paliperidone palmitate, and aripiprazole monohydrate. Due to the increasing number of BD patients receiving LAI antipsychotics, treatment guidelines have been developed. However, the clinical applicability of LAI antipsychotics remains a global cause for concern, particularly in Asian countries. Expert physicians from Taiwan participated in a consensus meeting, which was held to review key areas based on both current literature and clinical practice. The purpose of this meeting was to generate a practical and implementable set of recommendations for LAI antipsychotic use to treat BD; target patient groups, dosage, administration, and adverse effects were considered. Experts recommended using LAI antipsychotics in patients with schizophrenia, rapid cycling BD, BD I, and bipolar-type schizoaffective disorder. LAI antipsychotic use was recommended in BD patients with the following characteristics: multiple episodes and low adherence; seldom yet serious episodes; low adherence potential per a physician's clinical judgment; preference for injectable agents over oral agents; and multiple oral agent users still experiencing residual symptoms.


Bipolar disorder; Long-acting injectable antipsychotics; Risperidone; Consensus
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