- The lifetime prevalence of schizophrenia is estimated to be approximately 0.7%. Worldwide, schizophrenia is one of the top 20 causes of disability.
- Schizophrenia is also associated with increased mortality, with a shortened lifespan and standardized mortality ratios that are reported to be twofold to fourfold those in the general population. Individuals often have physical health comorbidities such as cardiovascular, respiratory, and infectious diseases and malignancies, particularly lung cancer.
- About 4%–10% of persons with schizophrenia die by suicide, with rates that are highest among males in the early course of the disorder. Additional causes of death also include other unnatural events such as accidents and traumatic injuries.
- Harms from therapeutic interventions may include:
- adverse events that range from serious to less serious but affect tolerability to minor
- negative effects of the intervention on quality of life
- barriers and inconveniences associated with treatment
- other negative aspects of treatment that may influence decision-making by the patient, the clinician or both.
- The guideline statements should be implemented in the context of a person-centered treatment plan that includes evidence-based nonpharmacological and pharmacological treatments for schizophrenia.
- See full text guideline for additional information.
Note: none of the subsequent statements are meant to stand alone.
- As outlined in APA’s Practice Guidelines for the Psychiatric Evaluation of Adults (3rd edition), APA recommends (1C) that the initial assessment of a patient with a possible psychotic disorder include:
- the reason the individual is presenting for evaluation
- the patient’s goals and preferences for treatment
- a review of psychiatric symptoms and trauma history
- an assessment of tobacco and other substance use
- a psychiatric treatment history
- an assessment of physical health
- an assessment of psychosocial and cultural factors
- a mental status examination, including cognitive assessment
- an assessment of risk of suicide and aggressive behaviors.
- APA recommends (1C) 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.
- APA recommends (1C) that patients with schizophrenia have a documented, comprehensive, and person-centered treatment plan that includes evidence-based nonpharmacological and pharmacological treatments.
Elements to consider as part of the treatment plan:
- pharmacological interventions
- psychotherapies and other psychosocial interventions
- engaging support
- addressing risks for suicide/aggression
- addressing tobacco and SUDs
- addressing other comorbid psychiatric symptoms, diagnoses
- addressing other comorbid health conditions
- pregnancy/postpartum concerns
- treatment setting
- involuntary treatment issues
- needs of patients in correctional settings
Suggested physical and laboratory assessments for patients with schizophrenia
|Assessment||Initial or baselinea||Follow-upb|
|Assessments to monitor physical status and detect concomitant physical conditions|
|Vital signs||Pulse, blood pressure||Pulse, blood pressure, temperature as clinically indicated|
|Body weight and height||Body weight, height, BMIc||BMIc every visit for 6 months and at least quarterly thereafter|
|Hematology||CBC, including ANC||CBC, including ANC if clinically indicated (e.g., patients treated with clozapine)|
|Blood chemistries||Electrolytes, renal function tests, liver function tests, TSH||As clinically indicated|
|Pregnancy||Pregnancy test for women of childbearing potential|
|Toxicology||Drug toxicology screen, if clinically indicated||Drug toxicology screen, if clinically indicated|
|Electrophysiological studies||EEG, if indicated on the basis of neurological exam or history|
|Imaging||Brain imaging (CT or MRI, with MRI being preferred), if indicated on the basis of neurological exam or historyd|
|Genetic testing||Chromosomal testing, if indicated on the basis of physical examination or history, including developmental historye|
|Assessments related to other specific side effects of treatment|
|Diabetesf||Screening for diabetes risk factors,g fasting blood glucoseh||Fasting blood glucose or hemoglobin A1C at 4 months after initiating a new treatment and at least annually thereafterh|
|Hyperlipidemia||Lipid paneli||Lipid paneli at 4 months after initiating a new antipsychotic medication and at least annually thereafter|
|Metabolic syndrome||Determine whether metabolic syndrome criteria are metj||Determine whether metabolic syndrome criteria are metj at 4 months after initiating a new antipsychotic medication and at least annually thereafterj|
|QTc prolongation||ECG before treatment with chlorpromazine, droperidol, iloperidone, pimozide, thioridazine, or ziprasidonek or in the presence of cardiac risk factorsl||ECG with significant change in dose of chlorpromazine, droperidol, iloperidone, pimozide, thioridazine, or ziprasidone,k or with the addition of other medications that can affect QTc interval in patients with cardiac risk factorsl or elevated baseline QTc intervals|
|Hyperprolactinemia||Screening for symptoms of hyperprolactinemiam Prolactin level, if indicated on the basis of clinical history||Screening for symptoms of hyperprolactinemia at each visit until stable, then yearly if treated with an antipsychotic known to increase prolactinm Prolactin level, if indicated on the basis of clinical history|
|Antipsychotic-induced movement disorders||Clinical assessment of akathisia, dystonia, parkinsonism, and other abnormal involuntary movements, including tardive dyskinesian|
Assessment with a structured instrument (e.g., AIMS, DISCUS) if such movements are present
|Clinical assessment of akathisia, dystonia, parkinsonism, and other abnormal involuntary movements, including tardive dyskinesia, at each visitn|
Assessment with a structured instrument (e.g., AIMS, DISCUS) at a minimum of every 6 months in patients at high risk of tardive dyskinesiao and at least every 12 months in other patientsp as well as if a new onset or exacerbation of preexisting movements is detected at any visit