Joel Yager, MD reviewing Galletly C et al. Aust N Z J Psychiatry 2016 May.

Clinicians worldwide may find these guidelines from “down under” to be of great use.

Sponsoring Organization: Royal Australian and New Zealand College of Psychiatrists

Target Population: Adults with schizophrenia spectrum disorders and those who are at ultra-high risk for these diagnoses

Background

These guidelines update those previously published in 2005.

Key Points

• Family and other social support, safe environments, and an adequate standard of living are critical for people with acute episodes or severe persistent illness.
• The recovery approach — fostering patient dignity, agency, and sense of meaning and achieving a “life worth living” — should be incorporated into all aspects of care.
• Patients should have access to specialist mental-health continuing-care teams and case management.
• Early management requires psychopharmacological and comprehensive psychosocial interventions that attend to housing, finances, education, and individually placed supported employment. Pharmacological management alone is insufficient.
• Early intervention for first-episode psychosis may prevent violence and self-harm.
• Switching antipsychotic agents requires planned, slow crossover titration. Short-term adjuvant therapies can minimize rebound phenomena.
• Electroconvulsive therapy may be of value combined with antipsychotic medications, in the treatment of both acute schizophrenia and treatment-resistant schizophrenia.
• Involuntary treatment for individuals who persistently refuse but who are likely to respond to treatment may reduce risks of serious harm and improve outcomes.
• Regular cardiometabolic screening and appropriate interventions should begin with the first episode of psychosis.
• Patients should receive attention for early and adult traumatic experiences, comorbid alcohol and substance abuse, and other comorbidities. Ongoing support for mothers with schizophrenia is essential.

Citation(s):

Galletly C et al. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders. Aust N Z J Psychiatry 2016 May; 50:410.

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