Initiating a long-acting injectable antipsychotic (MEQ)

(i) Early LAI offer. Frame as shared decision for adherence and relapse prevention after documented tablet misses — not punishment. Cite PRELAPSE: encouraging aripiprazole once-monthly in early-phase schizophrenia delayed first hospitalisation (HR ~0.56). Tiihonen FEP nationwide data: depot of same compound associated with roughly one-third rehospitalisation risk versus oral. Kishimoto multi-design meta-analysis supports LAI advantage on hospitalisation/relapse. Subotnik shows FEP risperidone LAI relapse advantage (context for early LAI philosophy even if agent differs).[1][2][3][4]

(ii) Pre-start. Confirm schizophrenia-spectrum diagnosis and that he is not already TRS. Assess capacity/consent, substance use, suicide/violence risk, support system, needle acceptability. Confirm oral aripiprazole tolerability (response and adverse effects). Baseline BMI/waist, BP, glucose/HbA1c, lipids, ECG if risk factors, pregnancy status if relevant. Plan injection logistics and reminder system.[2][3]

(iii) Aripiprazole monohydrate plan. Establish oral aripiprazole first. Give first monthly IM dose per product (commonly 400 mg monthly teaching scaffold if tolerated; 300 mg if needed). Provide about 14 days oral aripiprazole overlap after first injection (or an approved alternative initiation strategy if available locally). Book next injection; document site. Verify current SmPC for exact strengths and deltoid rules.[2]

(iv) Monitoring and missed doses. Metabolic and neurological monitoring as for oral aripiprazole at clinic contacts. Written missed-dose plan using product re-initiation windows; early contact if late. Integrate psychosocial care (family, early-intervention supports) — LAI is not full treatment alone.[3][6]

(v) Clozapine boundary. If later he meets TRRIP criteria (two adequate failed trials with adherence confirmed — LAI can help prove adherence) and remains symptomatic, offer clozapine rather than endless non-clozapine LAI cycling.[5]