The relationship between substance use disorders and schizophrenia has long intrigued mental health researchers and clinicians. When individuals develop psychosis in the context of substance use, what does that tell us in terms of etiopathophysiology and likely prognosis and outcome? How does one differentiate schizophrenia from substance-induced psychotic disorder? What are the treatment and prognostic implications of that distinction? In this presentation, the above questions will be addressed and clinical characteristics that enable differential diagnosis will be outlined. 

This presentation will focus on common errors and best practices when using long-acting injectable antipsychotics (LAIs). Key topics covered include: LAI Kinetics: The importance of understanding the kinetics of different LAI agents and which ones require loading injections or oral coverage. Combination Treatment: Detailed guidance on which oral or injectable agents can be combined. The presentation emphasizes that partial agonists like LAI aripiprazole have high D2 receptor affinity and should not be used in combination with other D2 antagonist LAIs. Specific Recommendations: For LAI aripiprazole, the presentation suggests adding oral xanomeline-trospium (XT) or clozapine. For other agents like LAI risperidone or paliperidone, it advises against combination LAIs and instead suggests either a dose increase of the oral agent or adding XT or clozapine. First-Generation Antipsychotics (FGAs): The presentation highlights that FGAs, such as haloperidol decanoate, still have a role in treatment and provides a simple conversion formula from oral to injectable doses. 

Despite advances in pharmacological and psychosocial interventions, many patients with schizophrenia continue to experience persistent symptoms, functional impairment, and reduced quality of life. This session will review evidence-based management strategies for treatment-resistant schizophrenia, including optimizing antipsychotic therapy, addressing adherence challenges, and evaluating augmentation. Dr. Christoph Correll will draw upon clinical trial data, meta-analyses, and real-world evidence to highlight practical approaches for improving long-term outcomes. 

This session will review novel pharmacological agents and mechanisms of action recently approved or in late-stage development for schizophrenia. Learners will gain insights into efficacy, safety, and tolerability data, as well as practical considerations for incorporating these latest and evidence-based therapies into individualized treatment plans.