The American Psychiatric Association Practice Guideline for the Treatment of Patients with Schizophrenia, Third Edition

Worldwide, schizophrenia is one of the top 20 causes of disability. The lifetime prevalence of schizophrenia is estimated to be approximately 0.7%, although findings vary depending on the study location, demographic characteristics of the sample, the approach adopted for case finding, the method employed for diagnostic confirmation, and the diagnostic criteria used. Economic burdens associated with schizophrenia are high, with an estimated cost of more than $150 billion annually in the United States on the basis of 2013 data. Additional research since the second edition of the guideline has expanded our knowledge of the effective and evidence-based interventions available to help reduce the mortality, morbidity, and significant psychosocial and health consequences of this important psychiatric condition. The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia seeks to reduce these substantial psychosocial and public health consequences for the individuals affected by schizophrenia. The guideline focuses specifically on evidence-based pharmacological and nonpharmacological treatments for schizophrenia and includes statements related to assessment and treatment planning, which are an integral part of patient-centered care. The guideline provides direction on implementing these recommendations into clinical practice, with the goal of improving the quality of care and treatment outcomes for patients with schizophrenia. Cover Title Copyright Contents Acronyms/Abbreviations Introduction Rationale Scope of Document Overview of the Development Process Rating the Strengths of Guideline Statements and Supporting Research Evidence Proper Use of Guidelines Guideline Statement Summary Guideline Statements and Implementation Assessment and Determination of Treatment Plan Statement 1: Assessment of Possible Schizophrenia Implementation Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement Review of Available Guidelines From Other Organizations Quality Measurement Considerations Statement 2: Use of Quantitative Measures Implementation Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement Review of Available Guidelines From Other Organizations Quality Measurement Considerations Statement 3: Evidence-Based Treatment Planning Implementation Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement Review of Available Guidelines From Other Organizations Quality Measurement Considerations Pharmacotherapy Statement 4: Antipsychotic Medications Implementation Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement Review of Available Guidelines From Other Organizations Quality Measurement Considerations Statement 5: Continuing Medications Implementation Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement Review of Available Guidelines From Other Organizations Quality Measurement Considerations Statement 6: Continuing the Same Medications Implementation Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement Review of Available Guidelines From Other Organizations Quality Measurement Considerations Statement 7: Clozapine in Treatment-Resistant Schizophrenia Implementation Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement Review of Available Guidelines From Other Organizations Quality Measurement Considerations Statement 8: Clozapine in Suicide Risk Implementation Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement Review of Available Guidelines From Other Organizations Quality Measurement Considerations Statement 9: Clozapine in Aggressive Behavior Implementation Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement Review of Available Guidelines From Other Organizations Quality Measurement Considerations Statement 10: Long-Acting Injectable Antipsychotic Medications Implementation Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement Review of Available Guidelines From Other Organizations Quality Measurement Considerations Statement 11: Anticholinergic Medications for Acute Dystonia Implementation Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement Review of Available Guidelines From Other Organizations Quality Measurement Considerations Statement 12: Treatments for Parkinsonism Implementation Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement Review of Available Guidelines From Other Organizations Quality Measurement Considerations Statement 13: Treatments for Akathisia Implementation Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement Review of Available Guidelines From Other Organizations Quality Measurement Considerations Statement 14: VMAT2 Medications for Tardive Dyskinesia Implementation Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement Review of Available Guidelines From Other Organizations Quality Measurement Considerations Psychosocial Interventions Statement 15: Coordinated Specialty Care Programs Implementation Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement Review of Available Guidelines From Other Organizations Quality Measurement Considerations Statement 16: Cognitive-Behavioral Therapy Implementation Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement Review of Available Guidelines From Other Organizations Quality Measurement Considerations Statement 17: Psychoeducation Implementation Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement Review of Available Guidelines From Other Organizations Quality Measurement Considerations Statement 18: Supported Employment Services Implementation Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement Review of Available Guidelines From Other Organizations Quality Measurement Considerations Statement 19: Assertive Community Treatment Implementation Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement Review of Available Guidelines From Other Organizations Quality Measurement Considerations Statement 20: Family Interventions Implementation Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement Review of Available Guidelines From Other Organizations Quality Measurement Considerations Statement 21: Self-Management Skills and Recovery-Focused Interventions Implementation Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement Review of Available Guidelines From Other Organizations Quality Measurement Considerations Statement 22: Cognitive Remediation Implementation Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement Review of Available Guidelines From Other Organizations Quality Measurement Considerations Statement 23: Social Skills Training Implementation Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement Review of Available Guidelines From Other Organizations Quality Measurement Considerations Statement 24: Supportive Psychotherapy Implementation Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement Review of Available Guidelines From Other Organizations Quality Measurement Considerations Areas for Further Research in Individuals With Schizophrenia Guideline Development Process Management of Potential Conflicts of Interest Guideline Writing Group Composition Systematic Review Methodology Rating the Strength of Supporting Research Evidence Rating the Strength of Guideline Statements Use of Guidelines to Enhance Quality of Care External Review Funding and Approval Glossary of Terms References Disclosures Individuals and Organizations That Submitted Comments Appendix A. Clinical Questions Appendix B. Search Strategies, Study Selection, and Search Results AHRQ Review Treatment of Neurological Side Effects of Antipsychotic Medications Appendix C. Review of Research Evidence Supporting Guideline Statements Assessment and Determination of Treatment Plan Statement 1: Assessment of Possible Schizophrenia Statement 2: Use of Quantitative Measures Statement 3: Evidence-Based Treatment Planning Pharmacotherapy Statement 4: Antipsychotic Medications Statement 5: Continuing Medications Statement 6: Continuing the Same Medications Statement 7: Clozapine in Treatment-Resistant Schizophrenia Statement 8: Clozapine in Suicide Risk Statement 9: Clozapine in Aggressive Behavior Statement 10: Long-Acting Injectable Antipsychotic Medications Statement 11: Anticholinergic Medications for Acute Dystonia Statement 12: Treatments for Parkinsonism Statement 13: Treatments for Akathisia Statement 14: VMAT2 Medications for Tardive Dyskinesia Psychosocial Interventions Statement 15: Coordinated Specialty Care Programs Statement 16: Cognitive-Behavioral Therapy Statement 17: Psychoeducation Statement 18: Supported Employment Services Statement 19: Assertive Community Treatment Statement 20: Family Interventions Statement 21: Self-Management Skills and Recovery-Focused Interventions Statement 22: Cognitive Remediation Statement 23: Social Skills Training Statement 24: Supportive Psychotherapy Appendix D. Strength of Evidence Table D–1. Pharmacological treatment Table D–2. Assertive community treatment (ACT) Table D–3. Cognitive-behavioral therapy (CBT) Table D–4. Cognitive remediation Table D–5. Family interventions Table D–6. Intensive case management Table D–7. Illness management and recovery Table D–8. Psychoeducation Table D–9. Social skills training Table D–10. Supported employment Table D–11. Supportive therapy Table D–12. Early interventions for patients with first-episode psychosis Table D–13. Co-occurring substance use and schizophrenia Back Cover "The goal of this practice guideline is to improve the quality of care and treatment outcomes for patients with schizophrenia. The guideline aims to help clinicians optimize care for their patients by providing evidence-based statements that are intended to enhance knowledge and increase the appropriate use of evidence-based pharmacological and nonpharmacological treatments for schizophrenia. In addition, it includes statements related to assessment and treatment planning, which are an integral part of patient-centered care"-- Provided by publisher