1 February 2004
American Psychiatric Association - Medical Specialty Society
Summary,

GUIDELINE OBJECTIVE(S)

To assist psychiatrists in assessing and treating adult patients with schizophrenia

TARGET POPULATION

Patients 18 years of age and older with schizophrenia, according to the criteria defined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV).

INTERVENTIONS AND PRACTICES CONSIDERED

Evaluation

1. Initial evaluation including complete psychiatric and general medical histories, assessment for substance use and physical and mental status examinations
2. Assessment of suicide potential and/or likelihood of dangerous or aggressive behavior
3. Laboratory, electrophysiological, and radiological assessments
* Pregnancy test in women of childbearing potential
4. More detailed studies as indicated (e.g., screening for heavy metal toxins, electroencephalogram (EEG), magnetic resonance imaging [MRI] scan, or computed tomography [CT] scan)

Treatment/Management

1. Patient/family education including discussion of risks and benefits of treatment
2. Psychosocial interventions
* Family interventions
* Supported employment
* Assertive community treatment
* Social skills training
* Cognitive behaviorally oriented psychotherapy
3. Antipsychotic medications
* First generation agents:
o Phenothiazines: Fluphenazine, trifluoperazine, perphenazine, mesoridazine, chlorpromazine, thioridazine
o Butyrophenone: Haloperidol
o Others: Thiothixene, molindone, loxapine
* Second generation agents: Aripiprazole, clozapine, risperidone, olanzapine, ziprasidone, and quetiapine
4. Adjunctive medications
* Benzodiazepines
* Antidepressants
* Mood stabilizers
* Beta-blockers
5. Other somatic therapies
* Electroconvulsive therapy (ECT)
* Repetitive transcranial magnetic stimulation (rTMS)
6. Treatment settings and housing options, including hospitalization and day treatment programs

MAJOR OUTCOMES CONSIDERED

* Morbidity and mortality associated with schizophrenia
* Frequency and severity of schizophrenic episodes
* Improvement (or diminution or reduction) in symptoms of schizophrenia
* Improvement in role functioning