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<h3>Background and Importance</h3> Long-acting injectable olanzapine (OLAI) is prescribed to stabilised schizophrenia patients previously treated with oral olanzapine to enhance therapeutic adherence and reduce relapse risk. In April 2025, a shortage of the 300 mg OLAI formulation occurred, followed in May by the 405 mg formulation. This led to drastic rationing and prioritisation based on clinical assessment and recommendations from the French National Agency for Medicines. While benefits of long-acting injections are well established, the consequences of drug shortages remain poorly studied in terms of continuity of care and clinical outcomes. <h3>Aim and Objectives</h3> To evaluate therapeutic adaptations to the olanzapine shortage and analyse clinical consequences in patients stabilised on OLAI. <h3>Material and Methods</h3> A single-centre retrospective cohort study was conducted between May and August 2025. Eligible patients were men and women of all ages from the active caseload of a public psychiatric hospital, either hospitalised or outpatient, stabilised on OLAI 300 mg or 405 mg – with at least three previous injections. Data were extracted from patient records and nursing reports. Primary outcomes were therapeutic adaptations (oral switch, antipsychotic change, dose adjustment) and clinical course (decompensation/rehospitalisation). <h3>Results</h3> Among the 34 patients, only two (6%) maintained their usual injection dosage. Most required adaptation: 22 (65%) switched to oral olanzapine, 10 (29%) underwent OLAI dose change. Of these, nine later switched to oral olanzapine, and one changed to another antipsychotic. Overall, 31 out of 34 patients switched to oral olanzapine. Among them, seven (21%) experienced decompensation, including one rehospitalisation. After the shortage, only 16 (47%) resumed OLAI. <h3>Conclusion and Relevance</h3> The shortage led to therapeutic adjustments in nearly all patients, with 21% decompensating, and one readmission. Although the rehospitalisation rate was low (3%), at a national scale, it could represent a major public health burden. These results highlight the vulnerability of psychiatric care pathways to shortages. Limitations include the retrospective, single-centre design, reducing generalisability of the results. Multicentre studies with health-economic analyses are needed to confirm these findings and better estimate the global impact. This study illustrates how a drug shortage can undermine years of clinical stability within weeks, underscoring the need for therapeutic continuity in psychiatry. <h3>Conflict of Interest</h3> No conflict of interest