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©The Author(s) 2026. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. Jan 19, 2026; 16(1): 113548
Published online Jan 19, 2026. doi: 10.5498/wjp.v16.i1.113548
Published online Jan 19, 2026. doi: 10.5498/wjp.v16.i1.113548
Initial lurasidone dosing in acute schizophrenia: Pragmatic and trajectory-aware clinical implications
Yang Liu, Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 300010, China
Tao Liu, Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
Author contributions: Liu T designed the overall concept and outline of the manuscript; Liu Y contributed to the discussion and design of the manuscript; Liu Y and Liu T contributed to the writing, and editing the manuscript, illustrations, and review of literature. Both authors approved the final version to publish.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tao Liu, MD, Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing 100053, China.
Received: August 27, 2025
Revised: September 13, 2025
Accepted: November 6, 2025
Published online: January 19, 2026
Processing time: 125 Days and 8.4 Hours
Revised: September 13, 2025
Accepted: November 6, 2025
Published online: January 19, 2026
Processing time: 125 Days and 8.4 Hours
Core Tip
Core Tip: Choosing a starting dose may influence the early clinical trajectory in acute schizophrenia. In a pragmatic randomized study, 80 mg/day for the first week led to more rapid improvement in Positive and Negative Syndrome Scale positive symptoms than 40 mg/day, with similar discontinuation for adverse events and no short-term metabolic penalty. Clinicians may prioritize speed with 80 mg/day when tolerated, or start at 40 mg/day when akathisia risk is a concern, coupled with a day-7 review for escalation. Open-label design and dose convergence temper causal claims, but initial dose selection may shape the early trajectory.