Last updated December 18, 2021

Treatment of Patients With Schizophrenia

Recommendations

Assessment and Determination of Treatment Plan

As outlined in APA’s Practice Guidelines for the Psychiatric Evaluation of Adults (3rd edition), APA recommends that the initial assessment of a patient with a possible psychotic disorder include: (1, C)
  1. the reason the individual is presenting for evaluation 
  2. the patient’s goals and preferences for treatment 
  3. a review of psychiatric symptoms and trauma history 
  4. an assessment of tobacco and other substance use 
  5. a psychiatric treatment history 
  6. an assessment of physical health 
  7. an assessment of psychosocial and cultural factors 
  8. a mental status examination, including cognitive assessment 
  9. an assessment of risk of suicide and aggressive behaviors. 
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APA recommends that the initial psychiatric evaluation of a patient with a possible psychotic disorder include a quantitative measure to identify and determine the severity of symptoms and impairments of functioning that may be a focus of treatment. (1, C)
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APA recommends that patients with schizophrenia have a documented, comprehensive, and person-centered treatment plan that includes evidence-based nonpharmacological and pharmacological treatments. (1, C)
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Pharmacotherapy 

APA recommends that patients with schizophrenia be treated with an antipsychotic medication and monitored for effectiveness and side effects.* (1, A)
The choice of medication should consider: 
  • addressing patient's non- or partial response 
  • side-effect profile 
  • presence of other health conditions that may be affected by medication side effects 
  • formulations 
  • interactions and metabolism 
  • pharmacokinetic properties 
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APA recommends that patients with schizophrenia whose symptoms have improved with an antipsychotic medication continue to be treated with an antipsychotic medication.* (1, A)
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APA suggests that patients with schizophrenia whose symptoms have improved with an antipsychotic medication continue to be treated with the same antipsychotic medication.* (2, B)
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APA recommends that patients with treatment-resistant schizophrenia be treated with clozapine.* (1, B)
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APA recommends that patients with schizophrenia be treated with clozapine if the risk for suicide attempts or suicide remains substantial despite other treatments.* (1, B)
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APA suggests that patients with schizophrenia be treated with clozapine if the risk for aggressive behavior remains substantial despite other treatments.* (2, C)
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APA suggests that patients receive treatment with a long-acting injectable antipsychotic medication if they prefer such treatment or if they have a history of poor or uncertain adherence.* (2, B)
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APA recommends that patients who have acute dystonia associated with antipsychotic therapy be treated with an anticholinergic medication. (1, C)
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APA suggests the following options for patients who have parkinsonism associated with antipsychotic therapy: lowering the dosage of the antipsychotic medication, switching to another antipsychotic medication, or treating with an anticholinergic medication. (2, C)
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APA suggests the following options for patients who have akathisia associated with antipsychotic therapy: lowering the dosage of the antipsychotic medication, switching to another antipsychotic medication, adding a benzodiazepine medication, or adding a beta-adrenergic-blocking agent. (2, C)
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APA recommends that patients who have moderate to severe or disabling tardive dyskinesia associated with antipsychotic therapy be treated with a reversible inhibitor of the vesicular monoamine transporter 2 (VMAT2). (1, B)
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Psychosocial Interventions 

APA recommends that patients with schizophrenia who are experiencing a first episode of psychosis be treated in a coordinated specialty care program.*
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APA recommends that patients with schizophrenia be treated with cognitive-behavioral therapy for psychosis (CBTp).* (1, B)
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APA recommends that patients with schizophrenia receive psychoeducation.* (1, B)
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APA recommends that patients with schizophrenia receive assertive community treatment if there is a history of poor engagement with services leading to frequent relapse or social disruption (e.g., homelessness; legal difficulties, including imprisonment).* (1, B)
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APA suggests that patients with schizophrenia who have ongoing contact with family receive family interventions.* (2, B)
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APA suggests that patients with schizophrenia receive interventions aimed at developing self-management skills and enhancing person-oriented recovery.* (2, C)
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APA suggests that patients with schizophrenia receive cognitive remediation.* (2, C)
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APA suggests that patients with schizophrenia who have a therapeutic goal of enhanced social functioning receive social skills training.* (2, C)
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APA suggests that patients with schizophrenia be treated with supportive psychotherapy.* (2, C)
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* This guideline statement should be implemented in the context of a person-centered treatment plan that includes evidence-based nonpharmacological and pharmacological treatments for schizophrenia. 


Recommendation Grading

Overview

Title

Treatment of Patients With Schizophrenia

Authoring Organization

Publication Month/Year

September 1, 2020

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Male, Adult, Older adult

Health Care Settings

Ambulatory, Correctional facility, Emergency care, Hospital, Long term care

Intended Users

Psychologist, counselor

Scope

Management, Treatment

Diseases/Conditions (MeSH)

D000071057 - Tardive Dyskinesia, D012559 - Schizophrenia, D014150 - Antipsychotic Agents

Keywords

schizophrenia, tardive dyskinesia, antipsychotics