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

Abstract

Objectives: This guideline provides recommendations for the clinical management of schizophrenia and related disorders for health professionals working in Australia and New Zealand. It aims to encourage all clinicians to adopt best practice principles. The recommendations represent the consensus of a group of Australian and New Zealand experts in the management of schizophrenia and related disorders. This guideline includes the management of ultra-high risk syndromes, first-episode psychoses and prolonged psychoses, including psychoses associated with substance use. It takes a holistic approach, addressing all aspects of the care of people with schizophrenia and related disorders, not only correct diagnosis and symptom relief but also optimal recovery of social function. Methods:The writing group planned the scope and individual members drafted sections according to their area of interest and expertise, with reference to existing systematic reviews and informal literature reviews undertaken for this guideline. In addition, experts in specific areas contributed to the relevant sections. All members of the writing group reviewed the entire document. The writing group also considered relevant international clinical practice guidelines. Evidence-based recommendations were formulated when the writing group judged that there was sufficient evidence on a topic. Where evidence was weak or lacking, consensus-based recommendations were formulated. Consensus-based recommendations are based on the consensus of a group of experts in the field and are informed by their agreement as a group, according to their collective clinical and research knowledge and experience. Key considerations were selected and reviewed by the writing group. To encourage wide community participation, the Royal Australian and New Zealand College of Psychiatrists invited review by its committees and members, an expert advisory committee and key stakeholders including professional bodies and special interest groups. RANZCP GuidelinesGalletly et al. 411 Australian & New Zealand Journal of Psychiatry, 50(5)Results: The clinical practice guideline for the management of schizophrenia and related disorders reflects an increasing emphasis on early intervention, physical health, psychosocial treatments, cultural considerations and improving vocational outcomes. The guideline uses a clinical staging model as a framework for recommendations regarding assessment, treatment and ongoing care. This guideline also refers its readers to selected published guidelines or statements directly relevant to Australian and New Zealand practice. Conclusions:This clinical practice guideline for the management of schizophrenia and related disorders aims to improve care for people with these disorders living in Australia and New Zealand. It advocates a respectful, collaborative approach; optimal evidence-based treatment; and consideration of the specific needs of those in adverse circumstances or facing additional challenges.

Current inpatient prescription practices for the treatment of schizophrenia in public hospitals of Minas Gerais, Brazil

“…(We were unable to find other reports of a similar nature in the literature.) Atypical antipsychotics are considered first-line choices by some, 5,6 but not all, 7 clinical guidelines, and there is a sustained debate on their economic advantages in developing countries. 8 Although clozapine has proven useful in reducing readmission risks in schizophrenia, 9 it was used in only 4.2% of admissions in our sample, a prevalence lower than that reported internationally (8-25%).…”

“…However, dose adjustment to optimal levels may not be as flexible as with oral antipsychotics, and prolonged side effects may occur, persisting even after discontinuation. 6 In international samples, longacting injectable antipsychotics are used in one-quarter to one-third of patients with schizophrenia. 12 The mean daily doses of antipsychotics prescribed in our sample were within internationally recommended dose ranges.…”

“…12 The mean daily doses of antipsychotics prescribed in our sample were within internationally recommended dose ranges. 3,13,14 The only exceptions were chlorpromazine and levomepromazine, which were used largely (87.8% and 92.6% of the time, respectively) used at doses o 300 mg/day, a practice not supported by pharmacotherapeutic guidelines, 5,6 but common in other countries as well. 10 Combining antipsychotics was a common practice (46.5% of all admissions), although much of this was due to the combined use of low-dose chlorpromazine and levomepromazine as sedative agents (34.0% of all admissions).…”

“…5,13,14 However, the absence of robust evidence in favor of antipsychotic combinations does not mean that patients would not respond to this strategy, which might justify the observed practice in selected patients, particularly in treatment-resistant cases. 6 Worldwide reports estimate the rate of combination antipsychotic therapy at 12-48%. 10,15 The most frequently prescribed adjuvant drugs were benzodiazepines (diazepam, clonazepam, lorazepam, nitrazepam, and midazolam), followed by anticholinergics (biperiden and promethazine), anticonvulsants (carbamazepine and valproate), and antidepressants (fluoxetine and tricyclics) ( Table 1).…”

“…Current treatment guidelines provide for the use of these advujants. 5,6 Benzodiazepines can be useful in managing anxiety, agitation, and psychosis. However, there is no good evidence to support their use in the longer term.…”