Long-Acting Antipsychotics: How They Work and Who They Help

Long-acting antipsychotic injections are several different medicines and delivery systems, not one drug. This first part of a three-part NP FADY series explains how LAIs work, which conditions they are approved for, who might consider one, and what the research does and does not show compared with daily pills.

Overview

A long-acting injectable antipsychotic, or LAI, releases medication over weeks or months. It can reduce the need to take an antipsychotic pill every day. The right choice depends on the condition being treated, the medication that helps you, its side effects, and your preferences. An injection changes how medicine reaches your body. It does not guarantee better results for everyone.[1,2]

What to know

• LAIs are several different medicines and delivery systems, not one drug.

• Some are approved for schizophrenia, some for bipolar I maintenance, and specific paliperidone products for schizoaffective disorder.[3,4]

• You can discuss an injection even if pills are working and you have never been hospitalized.

• Benefits can include fewer daily medication decisions. Burdens include injection visits and slower changes when unwanted effects occur.

• Treatment should support your own goals and include care beyond medication.[5,6]

Zoom

What does long-acting mean?

An LAI creates a supply of medication that the body absorbs gradually. Older materials may call this a “depot,” meaning a stored supply. Different products use different methods to control release. For example, haloperidol decanoate is carried in an oil solution,[7] while UZEDY forms a depot after an injection under the skin. These systems keep medication entering the bloodstream between appointments.[8]

The active medicine and its delivery system are separate choices. Risperidone is an active medicine; its different LAI products have their own release patterns and starting requirements. Paliperidone is closely related to risperidone: the body produces paliperidone while processing risperidone.[8] Aripiprazole lauroxil, used in ARISTADA, is a “prodrug,” a form the body converts into active aripiprazole.[2]

This distinction matters when comparing products. A familiar medicine in a new formulation may have a different appointment schedule without becoming a completely different treatment. But products containing related drugs are not automatically interchangeable. Part 2 explains the specific options and the checks needed before switching.

Long-acting injections differ from short-acting injections used for urgent symptoms. Both can go into a muscle, but their purposes and release patterns differ. A pill does not become an LAI because its effects last a long time.[9]

How do long-acting antipsychotics work?

There are two useful questions: What does the medicine do to the body, and what does the body do to the medicine?

“Pharmacodynamics” answers the first question. It describes how a drug interacts with receptors, which are small structures that receive chemical signals. “Pharmacokinetics” answers the second. It describes how the drug is released, absorbed, processed, and cleared. Understanding both helps explain why two injections can contain a related medicine but behave differently over time.[10]

Several LAI medicines block dopamine D2 receptors. “Block” means the medicine reduces the receptor’s response to dopamine at that site. Haloperidol is one example. Risperidone and paliperidone also act at dopamine and serotonin receptors. These actions are thought to contribute to benefit, but knowing which receptors a medicine binds does not fully explain how it improves a person’s symptoms.[11]

Aripiprazole works differently. It is a partial agonist at D2 receptors: it activates the receptor, but less strongly than a full agonist. It also partly activates serotonin 5-HT1A receptors and blocks 5-HT2A receptors. This is sometimes explained as adjusting a signal rather than simply blocking it. That comparison has limits. It does not mean aripiprazole measures a person’s dopamine level or always moves it toward a known “normal.”[12]

Other receptor actions help explain some unwanted effects. Olanzapine acts at histamine, muscarinic, and alpha-adrenergic receptors in addition to dopamine and serotonin receptors.[13] Its unwanted effects can include sleepiness, constipation, and dizziness.[9] A receptor chart cannot predict exactly how you will feel. Dose, other medicines, health conditions, and individual sensitivity also matter.

These treatments do not prove that a psychiatric condition is a simple chemical imbalance. Schizophrenia involves a complex mix of genetic, environmental, and brain-related factors.[5] FDA reviews can describe the clinical mechanism as unclear even while describing well-established receptor actions. A medicine can help without scientists having a complete explanation of the illness or its benefit.[8]

Why can one injection last weeks or months?

After an injection, medicine enters the bloodstream according to that product’s release pattern. The concentration, meaning the amount of drug in blood, can rise and fall. “Long-acting” does not mean perfectly flat levels. Haloperidol decanoate, for example, has a gradual rise and later decline. Its levels also vary between people.[7]

With repeated doses, a new injection may arrive while some medicine from earlier injections is still present. The overall pattern can build toward “steady state,” a more repeatable balance between medicine entering and leaving the body. This does not happen at the same speed for every product. Improvement in symptoms and reaching steady state are different events.[14]

“Half-life” describes the time it takes for the measured amount to fall by about half under specified conditions. It is not the date the drug disappears.[15] With an LAI, slow release from the injection site can make exposure last much longer than it would after a pill.[14]

This creates a practical tradeoff. Longer coverage can make daily medication routines easier. It can also mean that a dose change takes time to show its full effect. Medicine already given cannot simply be removed by declining the next appointment. If you develop an unwanted effect, tell the treatment team promptly so they can assess and manage it while the medication is still present.[14]

Which conditions can LAIs treat?

The word “antipsychotic” describes an important use of these drugs: reducing psychotic symptoms, such as hearing voices others do not hear or having strongly held beliefs that do not match shared reality. Some antipsychotics also have uses in mood disorders. The name of the drug class does not tell you every approved use of each product.[1]

US approvals differ by exact formulation:

• Schizophrenia is an approved use for many LAIs.

• INVEGA SUSTENNA has a specific adult schizoaffective disorder indication, alone or with mood stabilizers or antidepressants. Its indication should not be extended automatically to every paliperidone injection.[3]

• ABILIFY MAINTENA is approved for adult bipolar I maintenance as a single medication.[16] UZEDY is approved for adult bipolar I maintenance alone or alongside lithium or valproate.[17] Other approved bipolar options are compared in Part 2.

“Maintenance” means continuing treatment to help maintain improvement or prevent future episodes. It is different from treating an immediate episode. A bipolar maintenance approval does not establish that an injection treats bipolar depression. In the MAINTENA maintenance trial, the benefit mainly involved preventing manic recurrence; differences in depressive recurrence were not statistically clear.[18]

An oral medicine’s approval also does not automatically apply to its LAI. Ask about the exact product, condition, and phase of treatment. “Off-label” use means using an approved medicine for a condition, route, or dose outside its FDA-approved labeling. Ask what evidence supports the use, what remains uncertain, and which alternatives are available.[19]

Who might consider an antipsychotic injection?

You do not have to wait for repeated crises to ask about an LAI. The American Psychiatric Association includes LAIs among treatment options for people who prefer them. Its schizophrenia guidance also recognizes poor or uncertain medication adherence as a reason to consider this route. Here, adherence means how closely actual treatment matches the agreed plan.[6,20]

Daily pill-taking can be difficult for many reasons. A changing routine, memory problems, medication concerns, unwanted effects, or trouble getting refills can interfere. Those issues deserve a practical conversation. Before changing delivery, ask which problem needs solving. If nausea or restlessness is why you avoid a pill, receiving the same active drug by injection may not resolve that concern.[1]

Some people prefer fewer daily reminders of treatment. Others value the control and privacy of taking a pill at home. Needle fear, transport, time away from work, and clinic access can influence the decision. These are valid preferences to put on the table, not obstacles you have to hide. A useful conversation can begin with: “What would make treatment easier for me, and what burdens would this change create?”

Early-course treatment is also a reasonable setting for that discussion. Research has studied people soon after diagnosis or during the first several years of schizophrenia. Results are mixed, so an early LAI discussion should offer a choice rather than a promise of a superior outcome.[21]

Are antipsychotic injections more effective than pills?

They can offer an advantage, especially when daily medication gaps are an important part of the problem. But the size and consistency of that advantage depend on what is being compared and measured.

A randomized trial assigns treatment by chance, helping balance differences between groups. However, volunteers may receive reminders, frequent contact, and other support that make pill-taking easier than in usual care. A cohort study follows people treated in practice; its groups can differ in illness severity, support, or access. A before-and-after study compares the same person’s periods of treatment, but improvement after a crisis may partly reflect other changes or natural recovery. These are general reasons to read results in context, rather than assuming that every study answers the same question equally well.

A 2021 review combined 137 studies involving almost 400,000 people, mostly with schizophrenia or related conditions. LAIs were associated with fewer hospitalizations or relapses than oral antipsychotics across the three study types. The estimated difference was much larger in before-and-after studies than in randomized trials. That supports considering LAIs, while cautioning against treating the biggest estimate as a benefit everyone can expect.[22]

PRELAPSE studied 489 adults ages 18 to 35 with early-phase schizophrenia for two years. Clinics encouraged monthly injectable aripiprazole or offered usual care, which could include injections. Hospitalization occurred in 22% of the injection-strategy group and 36% of usual-care participants. The trial’s time-to-hospitalization analysis favored the injection strategy. It tested a care strategy involving staff training, not simply a pill and injection of the same medicine. Lundbeck and Otsuka funded it.[23]

EULAST asked a different question. It analyzed 511 adults with early-phase schizophrenia who were randomly assigned to injectable aripiprazole or paliperidone, or their oral versions, for up to 19 months. It found no statistically clear advantage in time until treatment was discontinued for any reason. This is not the same outcome as hospitalization. It also does not prove that both routes perform identically for every person.[24]

A 2024 review of early-phase randomized trials found no statistically clear overall difference in relapse or hospitalization, or in stopping treatment. Its authors rated confidence in the main estimates as very low because the studies varied and had quality problems. Some subgroup results favored injections, but they cannot identify with certainty who will benefit.[21]

Newer observational evidence adds another view. A 2025 analysis used international first-episode psychosis cohorts to estimate outcomes as if a trial had been conducted. It found little difference in 18-month hospitalization, but estimated seven fewer relapses per 100 people over three years after LAI initiation versus continued oral treatment. The uncertainty range was roughly one to twelve fewer. It was not a randomized trial, so unmeasured differences remain possible.[25]

Mortality research also needs care. A 2024 meta-analysis associated LAIs with lower overall mortality, while finding no statistically clear difference in suicide mortality. An underlying Taiwanese cohort likewise found an association with lower overall mortality. These findings do not establish that an injection itself causes longer life or removes suicide risk.[26,27]

The outcome matters. Fewer hospital visits do not automatically prove better memory, relationships, employment, or freedom from side effects. Discuss what success would look like for you and how it will be measured.

Do newer injections have fewer side effects?

“First generation” and “second generation” are broad categories, also called typical and atypical. They are not a ranking of which medicine is best for you.[1]

Part 2 discusses a direct trial showing different side-effect tradeoffs between paliperidone and haloperidol injections.[28]

Receiving a drug by injection does not erase its effects elsewhere in the body. The potential burdens include weight or metabolic changes, movement symptoms, sleepiness, and hormonal effects, depending on the medicine. Part 3 explains monitoring and when to contact the clinic.[1,3,5]

What if symptoms continue despite every injection?

This deserves assessment, not blame. Clinicians need to review the diagnosis, symptoms, treatment duration, side effects, other medicines, substance use, and whether enough medication has actually reached the body. Persistent symptoms despite adequate treatment are a different problem from symptoms occurring during gaps in exposure.[29]

Treatment-resistant schizophrenia generally involves inadequate response to at least two adequate antipsychotic trials, with careful assessment of medication exposure. An LAI can sometimes help establish that treatment has been delivered consistently. But changing the delivery system does not automatically solve true treatment resistance.[29]

The APA recommends clozapine for treatment-resistant schizophrenia. An LAI discussion should not keep someone in an endless series of similar treatments when a clozapine evaluation is appropriate. Clozapine has its own benefits, risks, and monitoring requirements; the question is whether it deserves consideration in that person’s plan.[6] As of September 30, 2026, there is no US FDA-approved long-acting clozapine injection.[30]

Recovery is bigger than the injection schedule

Reducing voices or preventing another episode can create room for other goals. Recovery may also mean returning to college, rebuilding trust, finding work, improving sleep, or enjoying time with friends. Medication alone may not address all of these needs.[5]

Psychotherapy, skills work, supported employment or education, and family education can help people manage daily life. For first-episode psychosis, coordinated specialty care brings several supports together, including medication, therapy, case management, and school or work services. The plan is built with the individual, rather than around medication alone.[5,31]

Families can contribute by asking what help the person wants. That might be a ride, a reminder, help preparing questions, or noticing a change in sleep. With the person’s agreement, support can make treatment more workable without turning every conversation into a medication check.

Frequently asked questions

Are LAIs only for schizophrenia?

No. Specific products also have adult bipolar I maintenance or schizoaffective indications. Approval depends on the exact product, not just the drug name.[3,16,17]

Do I have to miss pills before considering one?

No. Preference is a valid reason to discuss an injection. You can ask while an oral medicine is helping.[6]

Will an injection work right away?

Not necessarily. Release patterns and starting plans differ, and symptom improvement is separate from reaching a stable pattern of drug exposure.[2]

Does a partial agonist mean a weaker medicine?

No. It describes how a drug acts at a receptor, not a general ranking of clinical strength or suitability.[12]

Will it change my personality?

The aim is to reduce symptoms and support your functioning. If you feel overly sleepy, slowed, restless, or unlike yourself, describe that to the prescriber. Your experience should help shape the plan.[1,5]

Can I stop the effects by skipping the next injection?

No. Medication already given may keep entering the bloodstream. Discuss changes with the treatment team rather than assuming a missed appointment removes it.[2]

Are injections always safer than pills?

No. The molecule still has side effects, and the formulation adds its own practical issues. The safest fit depends on your health, medication history, and monitoring plan.[1,2]

What should I bring to my appointment?

Bring the name of your current medicine, what it helps, what bothers you, and any routine or access problems. Write down one goal you want treatment to support. Ask: “Could an injection help with that goal, and which disadvantages should we weigh before deciding?”

Continue with Part 2, Antipsychotic Injections: Comparing Your Treatment Options, and Part 3, Living With Antipsychotic Injections: Safety and Family Support.

Plain-language glossary of LAI terms

These terms help you read labels and discuss the plan with your care team. The definitions explain general concepts; the exact medicine determines its instructions.[1,2,5,10,15,32,33]

For the next visit, circle any term you want the clinician to explain using your own treatment plan.

Related reading on NP FADY

• Antipsychotic Injections: Comparing Your Treatment Options
• Living With Antipsychotic Injections: Safety and Family Support
• Weltruza: A Monthly Olanzapine Shot, and Everything to Ask Before the First Dose
• Cobenfy for schizophrenia: benefits, side effects, and dosing
• Bipolar and schizophrenia medicines in pregnancy and breastfeeding
• Why two opposite medicines both target dopamine

Educational disclaimer

This article is for education. It does not diagnose any condition, choose a medication for anyone, or replace the judgment of the clinician who knows your history. Do not start, stop, or change any medication without your prescriber. If there is imminent danger, or you cannot keep yourself or someone else safe, call 911 or go to the nearest emergency department. In the United States, call or text 988, or chat at 988lifeline.org, for any mental-health crisis. For a suspected overdose or accidental ingestion, call Poison Help at 1-800-222-1222. Regulatory and numeric claims in this article were checked against current FDA labeling and primary studies on September 30, 2026. Labels, approvals, and availability change; confirm current status with your prescriber or pharmacist before acting on anything here.

References

1. Mental Health Medications. National Institute of Mental Health. Last reviewed December 2023; accessed 2026-09-30. https://www.nimh.nih.gov/health/topics/mental-health-medications Accessed 2026-09-30.
2. ARISTADA NDA207533 Clinical Review. Lucas Kempf, MD; FDA CDER. 2015-10-02. https://www.accessdata.fda.gov/drugsatfda_docs/nda/2015/207533Orig1s000MedR.pdf Accessed 2026-09-30.
3. INVEGA SUSTENNA prescribing information. Janssen/Johnson & Johnson; FDA labeling reproduced by DailyMed. PI revised 2025-01; instructions 2025-02. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=1af14e42-951d-414d-8564-5d5fce138554 Accessed 2026-09-30.
4. ERZOFRI prescribing information. Luye Pharma / DailyMed. 2025-03 (full prescribing-information revision; retrieved September 30, 2026). https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=492bf9dd-868e-421a-92db-8cca8973aac1 Accessed 2026-09-30.
5. Schizophrenia. National Institute of Mental Health. Current federal patient resource; accessed 2026-09-30. https://www.nimh.nih.gov/health/publications/schizophrenia Accessed 2026-09-30.
6. APA Releases New Practice Guideline on Treatment of Patients with Schizophrenia. American Psychiatric Association. 2020-09-01. https://www.psychiatry.org/news-room/news-releases/apa-releases-new-practice-guideline-on-treatment-o Accessed 2026-09-30.
7. Haloperidol Decanoate Injection prescribing information. Generic product labeling reproduced by DailyMed. PI revised 2026-04. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=14f40303-9604-4a30-8e86-8abaeb177ce1 Accessed 2026-09-30.
8. UZEDY NDA213586 Multidisciplinary Review and Evaluation. FDA CDER multidisciplinary review team. 2023-04-28; includes 2022 clinical-pharmacology review. https://www.accessdata.fda.gov/drugsatfda_docs/nda/2024/213586Orig1s000MultidisciplineR.pdf Accessed 2026-09-30.
9. ZYPREXA RELPREVV prescribing information. H2-Pharma/Cheplapharm; FDA labeling reproduced by DailyMed. PI revised 2026-05; Medication Guide 2026-01. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=11544cba-64a9-49cb-8d74-da228053b252 Accessed 2026-09-30.
10. Clinical Pharmacology: Early Drug Development. Shirley K. Seo, PhD; FDA Office of Clinical Pharmacology. 2022-12-08. https://www.fda.gov/media/167545/download?attachment= Accessed 2026-09-30.
11. Risperidone compared with new and reference antipsychotic drugs: in vitro and in vivo receptor binding. Schotte A, Janssen PF, Gommeren W, et al.. 1996-03; Psychopharmacology 124:57-73. DOI 10.1007/BF02245606 PMID 8935801 https://pubmed.ncbi.nlm.nih.gov/8935801/ Accessed 2026-09-30.
12. Aripiprazole, a novel antipsychotic, is a high-affinity partial agonist at human dopamine D2 receptors. Burris KD, Molski TF, Xu C, et al.. 2002-07; J Pharmacol Exp Ther 302:381-389. DOI 10.1124/jpet.102.033175 PMID 12065741 https://pubmed.ncbi.nlm.nih.gov/12065741/ Accessed 2026-09-30.
13. Radioreceptor binding profile of the atypical antipsychotic olanzapine. Bymaster FP, Calligaro DO, Falcone JF, et al.. 1996-02-01; Neuropsychopharmacology 14:87-96. DOI 10.1016/0893-133X(94)00129-N PMID 8822531 https://www.nature.com/articles/1380401 Accessed 2026-09-30.
14. ARISTADA NDA207533 Clinical Pharmacology and Biopharmaceutics Reviews. FDA Office of Clinical Pharmacology review team. 2015 approval package; original clinical-pharmacology review 2015-04-20 with addenda. https://www.accessdata.fda.gov/drugsatfda_docs/nda/2015/207533Orig1s000ClinPharmR.pdf Accessed 2026-09-30.
15. Half-Life (t½). NIH ClinicalInfo HIV/AIDS Glossary. Undated; accessed 2026-09-30. https://clinicalinfo.hiv.gov/en/glossary/half-life-t-12 Accessed 2026-09-30.
16. ABILIFY MAINTENA prescribing information and Medication Guide. Otsuka; FDA labeling reproduced by DailyMed. DailyMed label version March 24, 2026; Medication Guide revised 03/2025. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ee49f3b1-1650-47ff-9fb1-ea53fe0b92b6 Accessed 2026-09-30.
17. UZEDY prescribing information. Teva; FDA labeling reproduced by DailyMed. PI revised 2025-10. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=734eb776-4be0-4808-834b-0d8b0f9e021e Accessed 2026-09-30.
18. Efficacy and Safety of Aripiprazole Once-Monthly in the Maintenance Treatment of Bipolar I Disorder: A Double-Blind, Placebo-Controlled, 52-Week Randomized Withdrawal Study. Calabrese JR, Sanchez R, Jin N, et al.. 2017-01-31 online; J Clin Psychiatry 78:324-331. DOI 10.4088/JCP.16m11201 PMID 28146613 https://www.psychiatrist.com/jcp/aripiprazole-once-monthly-for-bipolar-i/ Accessed 2026-09-30.
19. Understanding Unapproved Use of Approved Drugs Off Label. US Food and Drug Administration. Current federal patient resource accessed September 30, 2026. https://www.fda.gov/patients/learn-about-expanded-access-and-other-treatment-options/understanding-unapproved-use-approved-drugs-label Accessed 2026-09-30.
20. APA Guidelines Bundle: Treatment of Patients With Schizophrenia, pharmacotherapy recommendations. American Psychiatric Association; authorized Guideline Central pocket guide. 2020 guideline. https://eguideline.guidelinecentral.com/i/1303678-treatment-of-patients-with-schizophrenia/7 Accessed 2026-09-30.
21. Efficacy and safety of long-acting injectable versus oral antipsychotics in the treatment of patients with early-phase schizophrenia-spectrum disorders: a systematic review and meta-analysis. Vita G, Tavella A, Ostuzzi G, et al.. 2024-06-02; Therapeutic Advances in Psychopharmacology 14. DOI 10.1177/20451253241257062 PMID 38831918 https://pmc.ncbi.nlm.nih.gov/articles/PMC11145998/ Accessed 2026-09-30.
22. Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia: a systematic review and comparative meta-analysis of randomised, cohort, and pre-post studies. Kishimoto T, Hagi K, Kurokawa S, Kane JM, Correll CU. 2021-04-13 online; Lancet Psychiatry 8:387-404. DOI 10.1016/S2215-0366(21)00039-0 PMID 33862018 https://pubmed.ncbi.nlm.nih.gov/33862018/ Accessed 2026-09-30.
23. Effect of Long-Acting Injectable Antipsychotics vs Usual Care on Time to First Hospitalization in Early-Phase Schizophrenia: A Randomized Clinical Trial. Kane JM, Schooler NR, Marcy P, et al.. 2020-07-15 online; JAMA Psychiatry 77:1217-1224. DOI 10.1001/jamapsychiatry.2020.2076 PMID 32667636 https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2768027 Accessed 2026-09-30.
24. Efficacy of oral versus long-acting antipsychotic treatment in patients with early-phase schizophrenia in Europe and Israel: a large-scale, open-label, randomised trial (EULAST). Winter-van Rossum I, Weiser M, Galderisi S, et al.. 2023-01-27 online; Lancet Psychiatry 10:197-208. DOI 10.1016/S2215-0366(23)00005-6 PMID 36716759 https://pubmed.ncbi.nlm.nih.gov/36716759/ Accessed 2026-09-30.
25. Comparative effectiveness of long-acting injectable versus oral antipsychotic medication after a first episode of psychosis. Szmulewicz AG, Martinez-Ales G, Logan R, et al.; FEP-CAUSAL Collaboration. 2025-04-08; Nature Mental Health 3:421-428. DOI 10.1038/s44220-025-00407-5 https://www.nature.com/articles/s44220-025-00407-5 Accessed 2026-09-30.
26. All-cause mortality risk in long-acting injectable versus oral antipsychotics in schizophrenia: a systematic review and meta-analysis. Aymerich C, Salazar de Pablo G, Pacho M, et al.. 2024-08-22 online; Molecular Psychiatry 30:263-271, 2025 issue. DOI 10.1038/s41380-024-02694-3 PMID 39174648 https://www.nature.com/articles/s41380-024-02694-3 Accessed 2026-09-30.
27. Comparison of Long-Acting Injectable Antipsychotics With Oral Antipsychotics and Suicide and All-Cause Mortality in Patients With Newly Diagnosed Schizophrenia. Huang CY, Fang SC, Shao YHJ. 2021-05-11; JAMA Network Open 4:e218810. DOI 10.1001/jamanetworkopen.2021.8810 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2779762 Accessed 2026-09-30.
28. Effectiveness of Paliperidone Palmitate vs Haloperidol Decanoate for Maintenance Treatment of Schizophrenia: A Randomized Clinical Trial. McEvoy JP, Byerly M, Hamer RM, et al.. 2014-05-21; JAMA 311:1978-1987. DOI 10.1001/jama.2014.4310 PMID 24846035 https://jamanetwork.com/journals/jama/fullarticle/1872816 Accessed 2026-09-30.
29. Treatment-Resistant Schizophrenia: Treatment Response and Resistance in Psychosis (TRRIP) Working Group Consensus Guidelines on Diagnosis and Terminology. Howes OD, McCutcheon R, Agid O, et al.. 2016-12-06 online; American Journal of Psychiatry 174:216-229, 2017. DOI 10.1176/appi.ajp.2016.16050503 PMID 27919182 https://pubmed.ncbi.nlm.nih.gov/27919182/ Accessed 2026-09-30.
30. Clozapine tablets prescribing information and current US approval inventory check. NorthStar Rx; FDA labeling reproduced by DailyMed; current inventory reviewed against FDA and DailyMed. PI revised 2026-04; label updated 2026-05-11; inventory checked 2026-09-30. https://www.dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=61fe53d5-ed5c-4e45-9189-709d08d386cb Accessed 2026-09-30.
31. RAISE-ing the Standard of Care for Schizophrenia: The Rapid Adoption of Coordinated Specialty Care in the United States. National Institute of Mental Health. 2023. https://www.nimh.nih.gov/news/science-updates/2023/raise-ing-the-standard-of-care-for-schizophrenia-the-rapid-adoption-of-coordinated-specialty-care-in-the-united-states Accessed 2026-09-30.
32. APA Practice Guideline for the Treatment of Patients With Schizophrenia Third Edition clinician pocket guide. American Psychiatric Association / Guideline Central. 2020 guideline; authorized pocket guide linked from APA page updated 2025-09-12. https://eguideline.guidelinecentral.com/i/1303678-treatment-of-patients-with-schizophrenia/6 Accessed 2026-09-30.
33. VA/DoD Clinical Practice Guideline for Management of First-Episode Psychosis and Schizophrenia. US Department of Veterans Affairs / Department of Defense. April 2023, Version 2.0. https://www.healthquality.va.gov/HEALTHQUALITY/guidelines/MH/scz/VA-DOD-CPG-Schizophrenia-CPG_Finalv231924.pdf Accessed 2026-09-30.
34. The A1C Test and Diabetes. National Institute of Diabetes and Digestive and Kidney Diseases. Last reviewed April 2018; current resource accessed September 30, 2026. https://www.niddk.nih.gov/health-information/diagnostic-tests/a1c-test Accessed 2026-09-30.

If you or someone you know is in crisis

• Call 911 or go to your nearest emergency room for any life-threatening emergency.
• 988 Suicide & Crisis Lifeline — call or text 988, or chat at 988lifeline.org, available 24/7, free and confidential. En español: marque 988 y oprima 2, o envíe AYUDA al 988. Deaf or hard of hearing: 988 videophone (ASL) or TTY 711 then 988. Veterans: 988 and press 1, or text 838255.
• Crisis Text Line — text HOME to 741741.
• The Trevor Project (crisis support for LGBTQ+ young people) — call 1-866-488-7386, or text START to 678-678.
• National Sexual Assault Hotline (RAINN) — call 1-800-656-HOPE (4673) or text HOPE to 64673; free, confidential, 24/7. Online chat at RAINN.org/hotline.
• National Domestic Violence Hotline — call 1-800-799-SAFE (7233) or text START to 88788; 24/7, help in 200+ languages. Online chat at TheHotline.org. If your phone or computer may be monitored, calling from a safer device is an option.
• Riverside County — Inland SoCal Crisis Helpline 951-686-HELP (4357), 24/7 (Inland SoCal United Way / 211+, in partnership with RUHS-BH); Community Access, Referral, Evaluation and Support (CARES) Line 800-499-3008, 24/7.
• San Bernardino County — Access Unit (Behavioral Health Helpline) 888-743-1478, 24/7; Mobile Crisis/CCRT 800-398-0018 (24/7, all ages) or text 909-420-0560. Arrowhead Regional Medical Center (ARMC) has a dedicated walk-in adolescent psychiatric ER (ages 13–17).
• Children under 13 — call 911 for immediate danger, contact your county's mobile crisis team (they respond to all ages), or go to the nearest pediatric emergency room.
• California Peer-Run Warm Line (non-crisis — someone to talk to) — call or text 1-855-600-WARM (9276); daytime and evening hours, not a 24/7 line.
• NP Fady (non-emergency) — for routine scheduling or questions, call (909) 707-6261. This line is not monitored for emergencies.