World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Schizophrenia, Part 2: Long-term treatment of schizophrenia

Abstract

These guidelines for the biological treatment of schizophrenia were developed by an international Task Force of the World Federation of Societies of Biological Psychiatry (WFSBP). The goal during the development of these guidelines was to review systematically all available evidence pertaining to the treatment of schizophrenia, and to reach a consensus on a series of practice recommendations that are clinically and scientifically meaningful based on the available evidence. These guidelines are intended for use by all physicians seeing and treating people with schizophrenia. The data used for developing these guidelines have been extracted primarily from various national treatment guidelines and panels for schizophrenia, as well as from meta-analyses, reviews and randomised clinical trials on the efficacy of pharmacological and other biological treatment interventions identified by a search of the MEDLINE database and Cochrane Library. The identified literature was evaluated with respect to the strength of evidence for its efficacy and then categorised into four levels of evidence (A Á/D). This second part of the guidelines covers the long-term treatment as well as the management of relevant side effects. These guidelines are primarily concerned with the biological treatment (including antipsychotic medication, other pharmacological treatment options, electroconvulsive therapy, adjunctive and novel therapeutic strategies) of adults suffering from schizophrenia.Key words: Schizophrenia, long-term treatment, evidence-based medicine, practice guidelines, biological treatment, antipsychotics EXECUTIVE SUMMARY OF RECOMMENDATIONS General recommendationsSpecific treatment strategies are required not only for patients suffering from acute schizophrenia, but also in the stabilisation and stable phase of the disease. The stabilisation period follows the acute phase and constitutes a time-limited transition to continuing treatment in the stable phase. The stable phase represents a prolonged period of treatment and rehabilitation during which symptoms are under adequate control and the focus is on improving functioning and recovery. The goals of long-term therapy have to be discussed with the patient on the background of adequately provided information and his personal goals in order to find common ground to encourage a long-term medication strategy (shared-decision making). In this regard a treatment plan must be formulated and implemented. During the stabilisation phase, the main goals of treatment are to facilitate continued reduction in symptoms, consolidate remission, and promote the process of recovery. The main goals of treatment during the stable phase are to ensure that symptom remission or control is sustained, that the patient is maintaining or improving the level of functioning and quality of life, to prevent relapse, and to ensure that monitoring for adverse treatment effects continues. The antipsychotic pharmacological therapy should be accompanied by psychosocial interventions. A number of psychosocial...

Effectiveness of Lurasidone in Patients with Schizophrenia or Schizoaffective Disorder Switched From Other Antipsychotics

“…39 Guidelines from the British Association for Psychopharmacology, 40 World Federation of Societies of Biological Psychiatry, 41,42 and American Psychiatric Association 43 also offer switching advice. Specific guidance for switching strategies is also available through an online tool, SwitchRx (http://switchrx.ca/).…”

A review of hyperprolactinaemia and severe mental illness: Are there implications for clinical biochemistry?

“…79 The recommendations from the World Federation Society of Biological Psychiatry in 2005 curiously concluding that whereas prolactin elevation was frequent with amisulpride and typicals (.10%), it was measured only 'sometimes' (,10%) with risperidone. 80 Current data now seem to have clarified these frequencies rather differently.…”

Characteristics of Outpatients Initiated on Olanzapine versus Risperidone in the Treatment of Schizophrenia in Japan: A Healthcare Database Analysis

“…Effective pharmacological treatments are available, particularly for management of the positive symptoms [2][3][4][5]. One of the primary challenges psychiatrists face in treating schizophrenia is identifying the most appropriate antipsychotic medication for a given patient at a given point in time.…”

“…One of the primary challenges psychiatrists face in treating schizophrenia is identifying the most appropriate antipsychotic medication for a given patient at a given point in time. Treatment guidelines separate the antipsychotics into two groups: the older first-generation or typical antipsychotics, and the newer second-generation or atypical antipsychotics [2][3][4][5]. Two of the more commonly used atypical antipsychotics in Japan are olanzapine and risperidone [6].…”