LAIAs help intellectual disability patients with SMI, not off-label behavior

This within-person analysis clarifies that long-acting injectable antipsychotic benefit in people with intellectual disability depends heavily on whether a schizophrenia or bipolar diagnosis is present, a distinction directly relevant to the older, polypharmacy-burdened patients geriatric pharmacists frequently review.

long-acting injectable antipsychoticsoral antipsychoticsintellectual disabilityschizophreniabipolar disorderdepot antipsychoticsself-controlled case seriesextrapyramidal symptomsoff-label prescribinghealthcare utilisationpharmacoepidemiology Geriatrics / Geriatric Pharmacy

Background Information

LAIAs show promise for PWID with schizophrenia or bipolar disorder, but caution is needed for others.

The study explores the impact of long-acting injectable antipsychotics (LAIAs) versus oral antipsychotics (OAs) on healthcare utilisation in people with intellectual disability (PWID), a population with limited existing guidance. LAIA use was linked to reduced incidence of emergency department visits and psychiatric hospitalisations in PWID with schizophrenia/bipolar disorder, but increased cardiovascular hospitalisations compared to OAs. The data supports considering LAIAs for PWID with schizophrenia or bipolar disorder, while advising caution with off-label use in those without these diagnoses due to potential increased risks. LAIAs may benefit PWID with schizophrenia/bipolar disorder, but off-label use in other PWID requires careful evaluation.

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Authors: Leung SM, Lee KJ, Wei Y, Yan VKC, Deng EK, Deb S, Castle D, Huang C, Yiu HHE, Lui SS, Ng VWS, Lai FTT, Yan WC, Chan EW

Citation: Leung SM, Lee KJ, Wei Y, et al. Differences in associations between long-acting injectable and oral antipsychotic prescribing and healthcare utilisation in people with intellectual disability: a self-controlled case series (LOID study). BMJ mental health. 2026;29(1). doi:10.1136/bmjment-2026-302830

Article Links: PubMed · Journal / DOI · Free Full Text (PMC)

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Executive Summary

Study Design

Patient Population

Primary Outcomes

Secondary Outcomes & Safety Profile

Pharmacist Implications

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