The research, published in BMC Psychiatry by a team led by Shu-Yu Wu and Chia-Chien Liu of Taichung Veterans General Hospital, took advantage of a rich but underused resource: the structured electronic medical record, or EMR, data generated routinely during clinical care. Rather than relying on small, highly selected research samples or broad insurance claims, the investigators examined patient-level records from a tertiary medical center covering the period from January 1, 2017 to March 31, 2023. This retrospective, period-based observational design allowed them to capture the messy reality of clinical practice, where diagnoses evolve, medications change, and service use unfolds unevenly over time.

The analytic sample comprised 511 patients aged 18 years or younger who carried eligible mood disorder diagnoses, along with a small subgroup diagnosed with personality disorders. The cohort skewed female, with 355 patients, or 69.5 percent, being girls, and the mean age was 15.7 years. Within this group, 76 patients, or 14.9 percent, experienced psychiatric hospitalization during the observation window. That figure provides a useful benchmark for clinicians and health services researchers alike: in a tertiary-care, mood-disorder-focused youth population, roughly one in seven young people required inpatient psychiatric care.

To identify the characteristics associated with hospitalization, the researchers employed multivariable logistic regression, a statistical technique that estimates the independent contribution of each variable while holding the others constant. Their models incorporated demographic factors such as age and sex, broad diagnostic categories, medication exposures recorded at the index qualifying encounter, psychotherapy-related service exposure, and the duration of observation. This approach matters because naive comparisons can be deeply misleading. For example, if older adolescents are more likely to receive certain medications and also more likely to be hospitalized, a simple analysis might wrongly implicate the medication itself. Multivariable modeling helps disentangle such overlapping signals, although it cannot eliminate them entirely.

The results were striking in one central respect: treatment characteristics at the index encounter, rather than demographic or diagnostic categories, were the variables most consistently associated with hospitalization. Patients whose records showed exposure to antipsychotic medications at the index encounter had roughly three times the odds of hospitalization compared with those without such exposure, with an odds ratio of 3.03 and a 95 percent confidence interval spanning 1.65 to 5.57. Exposure to anticonvulsant medications used as mood stabilizers was similarly associated, with an odds ratio of 3.25 and a confidence interval of 1.16 to 9.09. Most dramatic of all was lithium: the 28 patients, or 5.5 percent of the cohort, with recorded lithium exposure at the index encounter showed an odds ratio of 10.64 for hospitalization, with a confidence interval of 3.76 to 30.12.

Before those numbers spark alarm about the medications themselves, the authors are emphatic about how they should be read. Lithium, antipsychotics, and anticonvulsant mood stabilizers are typically reserved for the most severe, complex, or treatment-resistant presentations in child and adolescent psychiatry. A teenager prescribed lithium for bipolar-spectrum illness is, almost by definition, a young person whose illness has already proved serious enough to warrant a potent agent with demanding monitoring requirements. In other words, these medication exposures function as markers of clinical severity and treatment complexity, not as causes of hospitalization. The study’s design, which records exposure at a single index encounter and observes hospitalization over a subsequent period, cannot establish temporal ordering or causal direction, and the authors explicitly caution against interpreting the odds ratios as medication effects.

Psychotherapy-related service exposure told a parallel story. Young patients whose records showed contact with psychotherapy services had seven times the odds of hospitalization, with an odds ratio of 7.00 and a confidence interval of 3.65 to 13.42. Again, the most plausible interpretation is not that therapy drives admission, but that both therapy and hospitalization reflect a higher intensity of care. Patients who are engaged in structured psychotherapy are often those with more severe symptoms, greater functional impairment, or more vigilant clinical follow-up, all of which increase the likelihood that a deterioration will be detected and escalated to inpatient treatment. The association captures care intensity, the authors note, without any established sequence of events linking the two.

Equally informative were the variables that failed to show significant associations. Age, sex, broad diagnostic category, and exposure to benzodiazepine anxiolytics were not significantly linked to hospitalization once other factors were accounted for. This null finding carries real weight. It suggests that, within a cohort already focused on mood disorders, knowing a patient’s age, sex, or coarse diagnosis adds little predictive value compared with knowing what treatments that patient is actually receiving. For risk assessment and service planning, the granular details of the clinical record may matter far more than the demographic and diagnostic boxes that often dominate intake summaries.

The study also examined all-cause emergency department utilization, though the authors frame this as descriptive context rather than an independent psychiatric outcome. Only 14 patients, or 2.7 percent of the cohort, had records of emergency department visits for any cause during the observation period, and 12 of those 14 also experienced psychiatric hospitalization. The tight overlap between emergency contact and inpatient admission suggests that, in this Taiwanese tertiary-care setting, the emergency department functioned less as a routine entry point for youth mental health crises and more as a way station on the path to admission. This pattern contrasts with settings where emergency departments serve as the primary access route for acute psychiatric care, and it offers a comparative data point for health systems designing crisis pathways for young people.

Beyond its specific findings, the study illustrates the growing power of real-world electronic medical record research in psychiatry. Tertiary-care EMR cohorts can capture service utilization patterns that randomized trials and survey-based studies miss, particularly in Asian healthcare settings where such data have historically been scarce. The authors conducted sensitivity analyses, including one restricted to outpatient-index encounters and another excluding patients with personality disorder diagnoses, to probe the robustness of their results, and the study received institutional review board approval with the informed consent requirement waived given the retrospective use of de-identified data. The practical implications point toward a shift in how clinicians and health systems think about risk: rather than relying on demographic profiles or diagnostic labels to anticipate which young patients may need hospitalization, attention should turn to the treatment trajectory itself. A prescription for lithium, an antipsychotic, or an anticonvulsant mood stabilizer, or active involvement in psychotherapy, signals a young person already navigating a severe and complex illness, and that signal may be the most actionable early warning a clinical team has. As electronic records grow richer and analytical methods mature, studies of this kind could help psychiatric services worldwide move from reactive crisis management toward genuinely anticipatory care for the most vulnerable children and adolescents.

Subject of Research: Correlates of psychiatric hospitalization among youth with mood disorders using electronic medical record data

Article Title: Correlates of psychiatric hospitalization in a mood-disorder-focused youth psychiatric cohort: a real-world electronic medical record study

Article References: Wu, S.-Y., Chen, I.-C., Lan, C.-C., Hu, Y.-W., & Liu, C.-C. (2026). Correlates of psychiatric hospitalization in a mood-disorder-focused youth psychiatric cohort: a real-world electronic medical record study. BMC Psychiatry. https://doi.org/10.1186/s12888-026-08699-2

Image Credits: AI Generated

DOI: 10.1186/s12888-026-08699-2

Keywords: child and adolescent psychiatry, psychiatric hospitalization, mood disorders, electronic medical records, mental health service utilization, lithium, antipsychotics, psychotherapy, emergency department utilization, Taiwan, logistic regression, bipolar disorder

The research team, led by investigators at Dongzhimen Hospital and Beijing University of Chinese Medicine together with colleagues at Ningbo Municipal Hospital of Traditional Chinese Medicine and Tsinghua University Yuquan Hospital, conducted a systematic review and network meta-analysis, a statistical technique that allows researchers to compare multiple treatments simultaneously, even when some treatments have never been tested head-to-head in the same trial. The team searched four major biomedical databases, PubMed, Embase, the Cochrane Library, and Web of Science, for randomized controlled trials published through December 5, 2025. To be included, studies had to evaluate metformin or a GLP-1 receptor agonist for at least twelve weeks in patients continuing antipsychotic treatment, ensuring that any measured metabolic changes reflected an intervention layered on top of ongoing psychiatric care rather than a change in the psychiatric medication itself.

The search ultimately captured twenty-nine randomized controlled trials encompassing 1,721 patients. The typical participant was young, with a median study-level age of 36.2 years, and slightly less than half of the pooled population, 47.7 percent, was male. The median treatment duration across the trials was sixteen weeks, long enough to capture meaningful changes in body weight and glucose metabolism but short enough to leave questions about durability unanswered. The researchers assessed the risk of bias in each trial using the Cochrane Risk of Bias 2.0 tool, the current gold standard for judging whether randomized studies were designed and conducted in ways that protect against inflated or misleading results.

At the heart of the analysis was a random-effects frequentist network meta-analysis performed in Stata 17.0 MP, a framework that pools direct comparisons between treatments with indirect ones to estimate how any two interventions would compare even without direct trial evidence. To rank the competing treatments, the team calculated SUCRA values, the surface under the cumulative ranking curve, a metric that expresses the probability that a given treatment ranks best across outcomes. They also deployed univariate network meta-regression to probe whether study-level characteristics, such as baseline weight or antipsychotic type, modified treatment effects, and they graded confidence in the findings using the CINeMA framework, short for Confidence in Network Meta-Analysis, which evaluates how much trust each estimate deserves based on the structure and consistency of the evidence network.

The headline result concerns semaglutide, the GLP-1 receptor agonist that has transformed obesity medicine in recent years. Compared with control groups, semaglutide was associated with a reduction in body mass index of 3.55 kilograms per square meter, with a 95 percent confidence interval spanning from 4.27 down to 2.84, a magnitude that in clinical terms represents a substantial improvement for a patient population in which weight gain of twenty or thirty kilograms is not uncommon. The drug also produced meaningful reductions in waist circumference, averaging 6.34 centimeters, in glycated hemoglobin A1c, the three-month average of blood sugar, which fell by 0.44 percentage points, and in fasting blood glucose, which dropped by 0.53 millimoles per liter. Together, these figures paint semaglutide as a broad-acting agent against the weight and glycemic dimensions of antipsychotic metabolic harm.

Metformin, by contrast, showed a different signature. The decades-old biguanide, which works largely by suppressing glucose production in the liver and improving insulin sensitivity, was associated with reductions in lipid metabolism markers, specifically total cholesterol and triglycerides, the blood fats most closely tied to cardiovascular risk. Intriguingly, the analysis also flagged an exploratory potential benefit for psychiatric symptom scores, with a standardized mean difference of 0.31 in favor of metformin, a small-to-moderate effect that, if confirmed, would suggest the drug might ease the burden of psychotic symptoms themselves rather than merely offsetting the metabolic cost of their treatment. The authors were careful to frame this finding as preliminary, but it adds to a growing body of speculation about links between insulin signaling, inflammation, and brain function in psychiatric illness.

The divergence in outcome profiles between the two drug classes is arguably the study’s most clinically useful message. GLP-1 receptor agonists mimic the gut hormone glucagon-like peptide-1, slowing gastric emptying, enhancing satiety, and prompting insulin release in a glucose-dependent manner, which explains their strength on weight and glycemic endpoints. Metformin’s mechanism, centered on AMPK activation and hepatic glucose suppression, aligns more naturally with lipid effects. For clinicians, this suggests the choice of adjunctive therapy could be tailored to a patient’s dominant metabolic problem: a patient ballooning in weight on olanzapine or clozapine might be a stronger candidate for a GLP-1 agonist, while one with worsening triglycerides might do better on metformin, at least until direct comparative trials settle the question.

That caveat matters, and the authors emphasize it forcefully. Because most trials in the network compared each drug against placebo rather than against each other, the estimates linking semaglutide and metformin are indirect, and the transitivity assumption, the premise that the trials being connected are similar enough in their populations and designs to be meaningfully compared, remains uncertain. The team explicitly describes their conclusions as exploratory evidence intended to inform clinical discussion and future research, not as definitive treatment guidance. The CINeMA-based confidence ratings reflect this caution, and the fact that the article was shared early as a peer-reviewed, accepted manuscript subject to further editorial processing adds another layer of provisional status to the findings.

Even with those limitations, the stakes of the research are difficult to overstate. People with schizophrenia die on average fifteen to twenty years earlier than the general population, and cardiovascular disease driven by antipsychotic-associated metabolic dysfunction is a leading contributor. Adherence is another casualty: patients who gain alarming amounts of weight frequently stop taking the very medications that keep their psychosis at bay, triggering relapse, hospitalization, and worsening long-term outcomes. An effective, well-tolerated metabolic countermeasure could therefore ripple across the entire trajectory of severe mental illness, improving not just waistlines and lab values but treatment persistence, relapse rates, and quality of life.

The study also arrives at a moment of intense public fascination with GLP-1 drugs, which have been hailed as near-miraculous for obesity and are being tested for everything from addiction to neurodegeneration. Applying them to antipsychotic-induced metabolic disturbances is a natural extension, but questions remain about cost, access, tolerability in psychiatric populations, and the theoretical concern that GLP-1 agents’ appetite suppression could interact with the weight dynamics of patients on antipsychotics. The authors’ funding, drawn from Chinese national and institutional sources including traditional Chinese medicine endocrinology programs, underscores the global nature of the effort to solve this problem. What the analysis delivers is a rigorous map of the current randomized evidence and a clear agenda: head-to-head trials directly comparing metformin and GLP-1 receptor agonists, longer follow-up to test durability, and studies powered to confirm whether metformin’s apparent psychiatric benefit is real. For the millions of patients whose lifesaving medications come with a metabolic tax, that research cannot come soon enough.

Subject of Research: Comparing metformin and GLP-1 receptor agonists for treating antipsychotic-induced metabolic disturbances

Article Title: Metformin and GLP-1 receptor agonists for antipsychotic-induced metabolic disturbances: a systematic review and network meta-analysis

Article References: Chen, Y.-X., Yang, Q.-W., Lin, M.-X., Sun, M.-H., Dong, Y.-Y., Yu, R.-D., Mao, D.-D., Zhao, Y., Zhang, L., Zhao, J.-X., Zhang, Y.-F., & Xu, J. (2026). Metformin and GLP-1 receptor agonists for antipsychotic-induced metabolic disturbances: a systematic review and network meta-analysis. BMC Medicine. https://doi.org/10.1186/s12916-026-05280-2

Image Credits: AI Generated

DOI: 10.1186/s12916-026-05280-2

Keywords: metformin, GLP-1 receptor agonists, semaglutide, antipsychotics, metabolic side effects, network meta-analysis, schizophrenia, obesity, BMI, HbA1c, psychiatry, BMC Medicine

The new research, published in Nature Mental Health, followed 510 young people, most of them antipsychotic-naive, who were starting, restarting, or switching to second-generation antipsychotics. The cohort, aged just 4 to 17 years and 55.7 percent male, was tracked for a full year with repeated assessments of body composition and of glucose and lipid metabolism. Crucially, the investigators verified adherence biochemically, measuring plasma concentrations of the drugs to confirm that participants were actually taking their prescribed medication. That single methodological choice distinguishes the study from much of the prior literature, where unknown adherence has long muddied attempts to connect drug exposure to metabolic outcomes.

The central question the team set out to answer is deceptively simple: when a child on an antipsychotic develops abnormal cholesterol or blood sugar, is that merely a consequence of the weight gain the drug induces, or is the medication directly perturbing metabolism through mechanisms that operate independently of body composition? The distinction matters enormously. If all metabolic harm flowed through adiposity, then monitoring weight would suffice. If, however, some drugs derail lipid and glucose regulation directly, then a child whose weight remains stable could still be quietly accumulating cardiovascular and diabetes risk that standard monitoring would miss.

To disentangle the two possibilities, the researchers used statistical strategies that controlled metabolic changes for changes in body weight and fat mass, and separately correlated metabolic shifts with those body composition measures. This dual approach allowed them to partition the observed dysregulation into body-composition-independent effects, driven by the drug itself, and body-composition-dependent effects, mediated by accumulating fat. The analytical code and a simulated dataset matching the structure of the SATIETY study were made publicly available, an unusual degree of transparency for naturalistic clinical research of this kind.

The results were striking. Increases in total cholesterol, fasting glucose, and triglycerides emerged that were independent of body composition, and these direct drug effects clustered by molecule. Olanzapine produced the most pronounced body-composition-independent metabolic worsening, with risperidone showing a partial but clearly present effect. By contrast, quetiapine and aripiprazole were associated with considerably less direct dysregulation of these markers. In other words, even in a child who gained little or no weight, olanzapine could push cholesterol and fasting glucose upward, while aripiprazole largely spared these parameters.

Insulin resistance told a different story. Rather than rising as a direct pharmacological effect, insulin resistance increased most strongly in association with changes in body composition, particularly fat mass. This finding aligns with the classical understanding of obesity-driven insulin resistance, in which expanding adipose tissue promotes inflammatory signaling, ectopic fat deposition, and impaired insulin signaling in muscle and liver. But it reframes the antipsychotic problem in an important way: weight gain is not simply a cosmetic side effect but the primary engine of one of the two major metabolic harms these drugs inflict on developing bodies.

The implications for clinical practice are immediate. Current monitoring guidelines for youths on second-generation antipsychotics typically emphasize weight, body mass index, and waist circumference, with metabolic laboratory testing recommended at intervals that are, in real-world settings, frequently skipped. The new findings suggest that body weight is an incomplete proxy. A young patient on olanzapine whose weight trajectory looks acceptable may nonetheless be experiencing direct, drug-driven rises in fasting glucose and triglycerides that only laboratory monitoring would detect. Conversely, a patient whose insulin sensitivity is deteriorating may benefit most from interventions targeting fat accumulation, such as metformin add-on treatment, lifestyle education, or a switch to a lower-risk agent like aripiprazole.

Why would antipsychotics act directly on lipid and glucose metabolism at all? Receptor-binding profiles offer a plausible mechanistic map. Many second-generation antipsychotics are potent antagonists at histamine H1, serotonin 5-HT2C, and muscarinic receptors, all of which participate in appetite regulation and, increasingly, evidence suggests, in peripheral metabolic control. Animal work has implicated central nervous system pathways in antipsychotic-induced glucose dysregulation that occurs before any measurable weight change, while translational studies point to effects of these drugs on lipid handling in adipose tissue and liver. Prior clinical observations in adults with schizophrenia, and a smaller randomized trial in youths, had hinted at weight-independent metabolic effects, but the new study provides the clearest demonstration to date in a large, well-characterized pediatric sample followed over a full year.

The naturalistic design brings both strengths and limitations. Because it captured real-world prescribing, the findings reflect the heterogeneous, ethically complex population that clinicians actually treat, including children with a range of severe mental illness diagnoses. Yet observational follow-up cannot fully exclude confounding by indication, illness severity, diet, and activity levels, and the researchers acknowledge that confidential patient data cannot be shared under ethical and data protection constraints. The team employed pattern-mixture modeling approaches to address missing data, but as with any cohort study, some residual uncertainty remains. Still, the plasma-verified adherence, the repeated measures, and the analytic separation of the two pathways give the conclusions unusual weight for this field.

What comes next is a test of whether the field can act on this refined understanding. The researchers argue that cardiometabolic monitoring in SGA-treated youths must extend beyond weight to include glucose and lipid panels throughout treatment, and that safer treatment alternatives deserve priority in both prescribing decisions and drug development. The findings also sharpen the case for structured interventions already supported by trial evidence, including metformin prophylaxis and antipsychotic switching strategies in overweight or obese youths. For the children and families navigating severe mental illness, the hope is that a more precise map of how these drugs harm metabolism will translate into treatment that protects the brain without quietly compromising the body.

Subject of Research: Metabolic side effects of long-term second-generation antipsychotic treatment in children and adolescents

Article Title: Body composition-mediated and drug-related metabolic dysregulation during long-term antipsychotic treatment in youth

Article References: Adam, T. J., Højlund, M., Pillinger, T., McCutcheon, R. A., Siskind, D., DelBello, M. P., Welge, J. A., Taipale, H., Tiihonen, J., Chang, W. C., McIntyre, R. S., Nielsen, R. E., Fink-Jensen, A., Solmi, M., & Correll, C. U. (2026). Body composition-mediated and drug-related metabolic dysregulation during long-term antipsychotic treatment in youth. Nature Mental Health. https://doi.org/10.1038/s44220-026-00721-6

Image Credits: AI Generated

DOI: 10.1038/s44220-026-00721-6

Keywords: antipsychotics, youth mental health, metabolic dysregulation, insulin resistance, body composition, olanzapine, risperidone, aripiprazole, cardiometabolic risk, pediatric psychopharmacology, glucose metabolism, drug safety

The authors begin with a deceptively simple question that the primary literature has largely ignored: who administers LAIs? In their experience across multiple institutions, practices vary dramatically. In some settings, injections are delivered exclusively by allied health professionals such as nurses, while physicians confine themselves to the prescription pad. In others, including community mental health centers, street psychiatry teams, assertive community treatment programs, solo private practices, and teaching hospitals where faculty must instruct trainees, the prescribing physician administers the injection directly. This patchwork of practice raises an obvious educational question: if the skill may be needed in practice, shouldn’t residency guarantee exposure to it?

The regulatory landscape offers little clarity. The Accreditation Council for Graduate Medical Education requires that psychiatry residents perform all “medical, diagnostic, and surgical procedures considered essential for the area of practice,” but provides no specific enumeration of which procedures qualify. The result, the authors report based on their own experience and communications with colleagues, is wide divergence among United States programs. At the University of Illinois Chicago, LAI administration is a required learning objective in the postgraduate year three and four, with residents expected to inject patients in clinic. At Northwestern Medicine, by contrast, injections are handled exclusively by nurses and support staff, and residents receive no opportunity to learn the procedure at all. Two prestigious programs in the same city, in other words, produce graduates with fundamentally different procedural skill sets.

The educational argument for requiring LAI training is compelling on its face. Experiential learning, the authors argue, sticks in ways that textbook reading does not. A resident who orders haloperidol decanoate and then draws up the correct volume from a multidose vial will understand dosing more deeply than one who merely reads about it. A resident who examines an injection site reaction and participates in its management gains clinical intuition that a secondhand description from a nurse cannot convey. Procedural competence also deepens prescriber empathy and knowledge, which in turn shapes how confidently physicians discuss these treatments with ambivalent patients.

The public health stakes are considerable, because LAIs are dramatically underutilized. Studies cited in the commentary show that only 19 to 30 percent of patients with schizophrenia are prescribed LAIs, and an analysis of the National Mental Health Services Survey found that only 30 percent of surveyed providers prescribe them at all. A major driver is prescriber knowledge and attitude: many psychiatrists view LAIs as a “last-resort” treatment or assume they are less effective in first-episode psychosis, beliefs contradicted by current evidence. Crucially, greater knowledge about LAIs is associated with more positive attitudes toward them. The implication is that residents who administer LAIs during training may be more likely to prescribe or deliver them afterward, slowly eroding the attitudinal barriers that keep an effective treatment class on the shelf.

Hands-on experience may also improve the therapeutic conversation itself. Initiating an LAI is often a delicate negotiation, since patients frequently have mixed feelings about injections versus oral medication, and some decline them because injections feel controlling or coercive. Notably, psychiatrists cite injection site pain as a reason for reluctance, yet only a minority of patients report it as a barrier, suggesting that unfamiliar prescribers misjudge the patient experience. Research also shows that the way a provider offers an LAI influences whether the patient accepts it. A physician who administers the injection personally may signal genuine faith in the treatment, reinforcing the therapeutic alliance, improving adherence, and ultimately increasing both patient and prescriber satisfaction.

There are career and access arguments as well. Some positions specifically require physicians who can administer LAIs, and graduates with the skill are more competitive for them; learning in residency offers a more structured, supportive environment than picking the technique up in practice. In resource-poor regions without support staff, a psychiatrist who can deliver injections may be the only person able to do so across a large geographic area, making the skill a matter of access, not just convenience. Offering both oral and long-acting formulations, tailored to individual patient factors, the authors contend, simply constitutes higher quality care.

Yet the commentary is careful to present the counterarguments, and they are substantial. Residents themselves often describe administering LAIs as repetitive, comparing it to drawing blood, with educational value that diminishes over years of exposure. Residency already presents an overwhelming range of learning objectives, and adding another risks work compression. The ACGME defines “non-physician obligations” as duties normally performed by nursing, allied health, transport, or clerical staff, and injection administration could plausibly fall under that umbrella, though the definition remains controversial. Burnout looms over the entire debate: up to 75 percent of resident physicians report symptoms of burnout, and the American Medical Association’s top cited stressors include too many administrative tasks and inadequate support staff. Layering a procedural requirement onto that load, critics would argue, only deepens the problem.

Practical infrastructure poses another obstacle. Proper LAI training demands staffing, pharmacy support, clinic space, supplies, scheduling, documentation, and navigation of state and institution-specific policies about whether residents may even perform the task. Many resident clinics, in the authors’ experience, lack key infrastructure or struggle to sustain it over time, and asking trainees to learn injections in an under-resourced clinic risks pushing them outside their comfort zone while degrading the patient experience. There is also a macro-level question: with a projected shortage of between 14,280 and 31,091 psychiatrists in the 2020s, is physician time spent holding a syringe the best allocation of a scarce resource, or should injections remain with allied health professionals?

Teng and Zimmerman come down, on balance, in favor of expanded training. They suggest programs could either mandate LAI training for all residents, maximizing public health benefit at the cost of significant resources, or offer it as an elective, capturing motivated trainees while risking low uptake. Either path requires deliberate support: protected time outside other clinical duties, instruction from qualified experts including pharmacists, nurses, and attending physicians, written reference materials, repeated observed practice with patients from continuity clinics, real-time supervision on request, extended 45-minute appointment slots to avoid work compression, and a clinical experience lasting at least six months to cover initiation, efficacy monitoring, and adverse effect management. The authors frame the debate as emblematic of a broader tension in graduate medical education, balancing educational and public health benefits against resident workload and burnout, and they call for research to characterize the diversity of educational approaches, codify best practices, and quantify the true costs and benefits of psychiatrists administering LAIs during training. Whether residency programs heed the call may shape not just a generation of psychiatrists’ skill sets, but the accessibility of one of psychiatry’s most underused treatments.

Subject of Research: Whether psychiatric residents should be required to learn to administer long-acting injectable medications during training

Article Title: Should Residents Be Required to Administer Long-Acting Injectables?

Article References: Teng, T. Z., & Zimmerman, E. C. (2026). Should Residents Be Required to Administer Long-Acting Injectables?. Academic Psychiatry. https://doi.org/10.1007/s40596-026-02441-6

Image Credits: AI Generated

DOI: 10.1007/s40596-026-02441-6

Keywords: long-acting injectables, psychiatry residency, medical education, antipsychotics, ACGME, resident burnout, schizophrenia, medication adherence, workforce shortage, psychopharmacology, clinical training, patient care