APA updates practice guideline for treating patients with schizophrenia
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The American Psychiatric Association has released a new evidence-based practice guideline for treating patients with schizophrenia, according to an organization press release.
The guideline includes several pharmacotherapy and psychosocial intervention recommendations intended to reduce the morbidity, mortality and significant adverse effects of this condition.
“Schizophrenia is a disorder that can be debilitating for people who experience it, and it is more prevalent than many of us would presume,” Jeffrey Geller, MD, MPH, APA president, said in the release. “This new guideline offers psychiatrists an approach to help patients that incorporates effective, evidence-based treatments as well as our patients’ preferences and goals. We encourage all psychiatrists and others who are interested to review the recommendations, which were developed by experts in researching and treating this complicated disorder.”
In an executive summary of the guideline published in American Journal of Psychiatry, George A. Keepers, MD, of the APA Practice Guideline Writing Group and professor of psychiatry at Oregon Health & Science University, and colleagues noted that numerous studies have expanded psychiatric knowledge of previously available treatments since publication of the last full practice guideline in 2004 and guideline watch in 2009 on schizophrenia. The APA Board of Trustees approved the current guideline at its December meeting. Its authors, led by Keepers, developed it using a systematic process intended to foster consistency with the recommendations of the Institute of Medicine and the Council of Medical Specialty Societies.
Keepers and colleagues recommended a documented, comprehensive and person-centered treatment plan that includes evidence-based pharmacological and nonpharmacological treatments for patients with schizophrenia. Pharmacotherapy recommendations include administration of antipsychotic medication with monitoring for adverse events and effectiveness, as well as continuation of medication for individuals whose symptoms have improved; clozapine for patients with treatment-resistant schizophrenia or who have substantial risk for suicide or suicide attempts; and long-acting injectable antipsychotics for patients who prefer them. Psychosocial intervention recommendations include coordinated specialty care programs for patients with a first episode of psychosis and cognitive behavioral therapy for psychosis, psychoeducation and supported employment services.
“In the absence of more robust evidence, the statements in this guideline should generally be applicable to individuals with co-occurring conditions, including individuals who receive treatment using integrated collaborative care or inpatient or outpatient medical settings,” Keepers and colleagues wrote. “Although treatment-related costs are often barriers to receiving treatment and cost-effectiveness considerations are relevant to health care policy, cost-effectiveness considerations are outside the scope of this guideline and its recommendations.”