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Paliperidone depot is not different from haloperidol in relapse prevention of schizophrenia, but different side effects should be considered
  1. Oliver Freudenreich
  1. Department of Psychiatry, Massachusetts General Hospital, Erich Lindemann Mental Health Center, Boston, Massachusetts, USA
  1. Correspondence to Dr Oliver Freudenreich, ofreudenreich{at}

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What is already known on this topic?

Reducing the occurrence of relapse in schizophrenia is an important treatment goal. Antipsychotics are effective in reducing relapse rates but they are often not taken regularly because of poor tolerability or difficulties taking oral pills reliably due to chaotic lives and cognitive difficulties.1 For such patients, a well-tolerated, long-acting injectable (LAI) antipsychotic seems an ideal approach. Very little is known about the comparative effectiveness of LAI antipsychotics with regards to relapse prevention.

What does this paper add?

  • This is the first trial that directly compared a first-generation with a second-generation long-acting injectable (LAI). It is also one of the few trials of haloperidol decanoate that used an optimal dose (ie, not an excessively high dose which was typical of older trials).

  • Even though a previous relapse-prevention trial comparing the oral administration of haloperidol with oral risperidone found a reduced relapse rate from the second-generation antipsychotic,2 the present study found similar efficacy failure rates of about 33% over 2 years for the …

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  • Competing interests OF served as independent outcomes adjudicator for ACLAIMS.