Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of schizophrenia and related disorders

Abstract

This guideline provides evidence-based recommendations for the management of schizophrenia by treatment type and by phase of illness. The essential features of the guidelines are: (i) Early detection and comprehensive treatment of first episode cases is a priority since the psychosocial and possibly the biological impact of illness can be minimized and outcome improved. An optimistic attitude on the part of health professionals is an essential ingredient from the outset and across all phases of illness. (ii) Comprehensive and sustained intervention should be assured during the initial 3-5 years following diagnosis since course of illness is strongly influenced by what occurs in this 'critical period'. Patients should not have to 'prove chronicity' before they gain consistent access and tenure to specialist mental health services. (iii) Antipsychotic medication is the cornerstone of treatment. These medicines have improved in quality and tolerability, yet should be used cautiously and in a more targeted manner than in the past. The treatment of choice for most patients is now the novel antipsychotic medications because of their superior tolerability and, in particular, the reduced risk of tardive dyskinesia. This is particularly so for the first episode patient where, due to superior tolerability, novel agents are the first, second and third line choice. These novel agents are nevertheless associated with potentially serious medium to long-term side-effects of their own for which patients must be carefully monitored. Conventional antipsychotic medications in low dosage may still have a role in a small proportion of patients, where there has been full remission and good tolerability; however, the indications are shrinking progressively. These principles are now accepted in most developed countries. (vi) Clozapine should be used early in the course, as soon as treatment resistance to at least two antipsychotics has been demonstrated. This usually means incomplete remission of positive symptomatology, but clozapine may also be considered where there are pervasive negative symptoms or significant or persistent suicidal risk is present. (v) Comprehensive psychosocial interventions should be routinely available to all patients and their families, and provided by appropriately trained mental health professionals with time to devote to the task. This includes family interventions, cognitive-behaviour therapy, vocational rehabilitation and other forms of therapy, especially for comorbid conditions, such as substance abuse, depression and anxiety. (vi) The social and cultural environment of people with schizophrenia is an essential arena for intervention. Adequate shelter, financial security, access to meaningful social roles and availability of social support are essential components of recovery and quality of life. (vii) Interventions should be carefully tailored to phase and stage of illness, and to gender and cultural background. (viii) Genuine involvement of consumers and relatives in service development and provision ...

The prevalence of abnormal findings in screening CT brains performed on patients admitted with psychiatric symptoms

“…They do, however, acknowledge that evidence regarding the possibility of routine CT imaging altering patient outcomes or clinical management is currently not available and needs to be explored. 2 Background: No clear guidelines exist regarding the role of computerised tomography (CT) as a screening neuroimaging tool in psychiatric practice. The aim of this study was to evaluate the usefulness of historical and clinical parameters on the CT request form, identify the spectrum of CT findings and correlate these to develop guidelines for the use of screening CT brains in patients who present with psychiatric symptoms.…”

The Use of Long-Acting Injectable Antipsychotics in Schizophrenia

“…Nurses in particular may play an important role in patient attitudes toward LAIs. 120 Nurses spend the most time with patients and family and may have a significant influence on perception of LAI therapy. There is an urgent need for training of mental health professionals, including social workers, nurses, and peer counselors.…”

“…Several schizophrenia management guidelines, including those by the American Psychiatric Association, recognize LAIs as a treatment option but usually only when nonadherence to oral medication has resulted in repeated schizophrenia relapses or when LAI is preferred by the patient. [119][120][121][122] However, even when guidelines recommend LAIs as an option if preferred by the patient, many patients may not be aware that LAIs are available.…”

The Quality of Internet Websites for People Experiencing Psychosis: Pilot Expert Assessment

“…The sixth subscale was adapted from bipolar disorder–specific to schizophrenia-specific content. The Brief Psychiatric Rating Scale [ 28 ] and information derived from the Royal Australian and New Zealand College of Psychiatrists Clinical Practice Guidelines for Treatment of Schizophrenia and Related Disorders [ 29 ] were used as the basis for developing the 29-item disorder-specific subscale measuring Breadth and Accuracy of the diagnostic and treatment-related information on psychosis.…”