Expert consensus recommendations on the use of long-acting injectable antipsychotics for schizophrenia in Saudi Arabia: results of a Delphi study

Abstract Background Long-acting injectable antipsychotics (LAIs) are effective in reducing relapse and rehospitalization in schizophrenia; however, they remain underutilized in routine clinical practice and are mainly reserved for patients with multiple relapses or adherence issues. Variability in clinical practice, limited familiarity with LAIs, and misconceptions about patient acceptability highlight the need for locally relevant, evidence-based guidance in Saudi Arabia. Objectives To develop expert consensus recommendations on the use of long-acting injectable antipsychotics in the management of schizophrenia in Saudi Arabia, addressing indications, timing of initiation, dosing strategies, monitoring, and implementation considerations. Methods A modified Delphi methodology was employed. An expert panel of consultant psychiatrists practicing in Saudi Arabia with at least five years of experience in schizophrenia management participated in two Delphi rounds. Consensus statements were developed following a literature review of international guidelines and relevant studies. Participants rated their agreement using a 5-point Likert scale. Consensus was predefined as ≥ 75% agreement (“agree” or “strongly agree”). Results Twenty-three experts completed Round 1, and twenty experts completed Round 2 (response rate: 87%). All 18 consensus statements met the predefined agreement threshold following two iterative rounds. Overall, consensus supported the use of LAIs across multiple stages of schizophrenia, including early-phase illness and first-line maintenance therapy following an adequate oral trial. Key recommendations emphasized shared decision-making, early consideration of LAIs, individualized formulation selection, cautious dosing adjustments, regular monitoring, and timely initiation of clozapine for treatment-resistant schizophrenia. Conclusion This Delphi-based expert consensus provides evidence-informed recommendations to guide the optimal use of LAI antipsychotics in Saudi Arabia. The findings support broader and earlier adoption of LAIs, standardized monitoring practices, and patient-centered decision-making, with the aim of reducing relapse, improving adherence, and enhancing long-term outcomes for patients with schizophrenia.