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The combination of ECT and antipsychotic medications can be considered as an option for people with schizophrenia when the goal is rapid global improvement and symptomatic reduction, as well as in patients who show a limited response to medication alone. To our knowledge, there are many reports of successful treatment of schizophrenia and schizoaffective disorder with ECT and long-acting injectable (LAI) antipsychotics. To date there is no report about the combination of paliperidone palmitate injection (PLP LAI) and ECT. We aimed to describe 4 cases of schizophrenia spectrum disorder patients safely treated with a combination of PLP LAI and ECT. EU was a 43-year-old male, married, and has been retired due to the illness for 9 years, with a diagnosis of schizoaffective disorder. At the admission, he refused treatment from oral route. So we decided to use PLP LAI for his treatment. No improvement was noted; he continued to display psychotic symptoms and psychomotor agitation. We decided to add ECT on. He was acutely started receiving ECT and went under 8 sessions of ECT. OS was 46-year-old, unmarried female, left school of medicine because of her illness, psychotic disorder and Obsessive compulsive disorder since 23 years old. Her medications at the time of her admission included şuvoxamine 300 mg/day, quetiapine 400 mg/day, and lorazepam 3 mg/day. Over the first several days, she routinely refused to take her medications, to take food and to leave her room in the hospital. Her treatment was changed to PLP LAI and ECT. She received totally 15 sessions of ECT. SI is a 39 year-old, married female, a housewife who has been suffering schizoaffective disorder for 3 years. Her admission treatment included valproic acid 1000 mg/day combined with chlorpromazine 200 mg/day and quetiapine 600 mg/day. Her treatment was continued for 10 days; there was no clinical improvement and a treatment with PLP LAI and ECT was planned. She went under 10 sessions of ECT. BD was a 30-year-old male, unmarried, unemployed, who had a history of schizoaffective disorder. Since the patient did not show clinical improvement and enough response to a variety of pharmacological treatment approaches, (paliperidone long action injection 100 mg/month, valproic acid 1000 mg/day, lorazepam 5 mg/day), ECT was planned and valproic acid and lorazepam were stopped. He went under 8 sessions of ECT. All patients were free from any comorbid medical condition; the physical examination and routine blood tests were normal To our knowledge, there were studies about clinical use of tablet form of paliperidone and ECT together but this is the first report of using PLP LAI with ECT. As a result, PLP LAI and ECT can be a safe and effective treatment choice in patients diagnosed with schizophrenia spectrum disorders, who don’t want to use oral medications regularly and who have resistance to contribute to the treatment like we presented above.