Lack of adherence is a common cause of relapse in schizophrenia. Long-acting antipsychotics have shown in recent studies that they improve compliance. However, some randomised controlled trials showed no difference in relapse rates between oral medication and long-acting injections.

To report the use of paliperidone palmitate in an Acute Psychiatrist Unit in Spain.

Retrospective observational study of 42 patients prescribed paliperidone palmitate (PLAI) during an admission at Acute Psychiatric unit in Málaga. In the mirror image analysis, the main outcome measure was the total number of days of psychiatric inpatient care twelve months before and after patients started Paliperidone palmitate.

Most common reason for starting paliperidone palmitate was lack of adherence to oral medication (54%) followed by lack of efficacy on previous medication (31%). Olanzapine (47%) and risperidone (41%) were most commonly antipsychotics prescribed before PLAI. Thirty-four patients continued PLAI over twelve months (80%). Poor compliance was the most common reason of withdrawal. Three patients had a movement disorder adverse effect. Only one was lost because adverse effects. Total admissions and inpatients days were significantly reduced from the previous treatment to PLAI-treatment period (Table 1).

PLAI was associated with a reduction in total inpatient days. The financial saving from reduced admissions stays exceeded the acquisition and administration cost of PLAI. Improved compliance because of PLAI is the most plausible explanation of this result (Fig. 1).