In 2008 olanzapine Galunisertib in vivo long-acting injection (OLAI) was licensed for the maintenance treatment of adult patients with schizophrenia sufficiently stabilized during acute treatment with oral olanzapine. During the clinical trial process it was recognized that in 0.07% of injections, a clinical syndrome presented as an adverse event that was consistent with the inadvertent intravenous administration

of olanzapine [Zypadhera, 2011; Detke et al. 2010; McDonnell et al. 2010] and resulting in the symptoms and signs of olanzapine overdose. This has been given the term post-injection delirium/sedation syndrome (PDSS) [Zypadhera, 2011]. The symptoms can be readily identified and have a median onset time of 25 min [Detke Inhibitors,research,lifescience,medical et al. 2010]. In an Inhibitors,research,lifescience,medical effort to minimize the incidence of PDSS, the Committee for Medicinal Products for Human Use mandated in the SPC for OLAI that the depot injection should only be administered in a healthcare facility; other requirements include a 3 h observation period after each injection that would allow any of the

symptoms and signs of PDSS to be detected by appropriately qualified personnel [Zypadhera, 2011]. For the remainder of the day after injection, patients should be advised to be vigilant for signs and symptoms of overdose secondary to postinjection adverse reactions, be able to obtain Inhibitors,research,lifescience,medical assistance if needed, and should not drive or operate machinery. In addition, patients should not travel alone to their destination after the 3 h of observation. Currently, OLAI is the only antipsychotic

treatment that contains such a mandate in its license and thus service providers have been challenged with providing a service whereby OLAI can be administered in accordance with the licence. We present three Inhibitors,research,lifescience,medical clinical cases with details of how this has been managed in a clinical setting, which to our knowledge presents the first case series reported on OLAI usage in clinical practice. Results Case 1 A 24-year-old man who was a former university student with a 4-year history of schizophrenia initially responded well to 20 mg olanzapine but subsequently Inhibitors,research,lifescience,medical became nonadherent to medication with little insight into his illness and need for treatment. OLAI was commenced at 300 mg every 2 weeks in October 2010 and subsequently reduced science to 405 mg every 4 weeks. The man began attending an existing acute day care service to receive his injection and undergo observation, staffed by nurses and occupational therapists taking part in their ongoing programme of activities. During the initial 12 months he has not missed an appointment. His clinical state has improved and he has gained some insight and so is able to do some voluntary work in a shop. He is accompanied to the clinic by a keyworker. Case 2 A 48-year-old man diagnosed with his first episode of schizophrenia in 2008 following a long period of untreated psychosis presented with delusional beliefs about a neighbour. A diagnosis was made of paranoid schizophrenia.