Bipolar disorder (BD) with psychotic features is a difficult-to-treat form of the illness that is associated with a poor prognosis. We hypothesized that treatment with adjunctive risperidone long-acting injectable (RLAI) is well-tolerated and efficacious in treating patients with psychotic BD. Ten patients with BDI or BDII with psychotic features who were refractory to earlier treatments were prescribed adjunctive open-label RLAI 25–62.5 mg q twice weekly. The patients were followed prospectively for 3 years. The severity of mood and psychotic symptoms was measured using clinical rating scales, and information regarding relapses, hospitalizations, extra-pyramidal symptom, weight gain, and other side effects was also gathered. Young Mania Rating Scale scores, Montgomery Asberg Depression Rating Scale scores, psychosis rating scale scores, and the numbers of mood episodes and hospitalizations were reduced during 3 years of RLAI therapy compared with an equivalent pretreatment period. Only three patients experienced relapses with psychotic symptoms. Functional outcomes were also improved, with substantial numbers of previously disabled patients able to return to gainful employment and independent living. RLAI was associated with minimal extra-pyramidal symptom, modest weight gain, and few other side effects. Adjunctive RLAI can be considered as a treatment option in patients with psychotic BD.