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Cited by 436Schizophrenia research and treatmentClinical practice guidelines implementationMental Health and Psychiatry

Royal Australian and New Zealand college of psychiatrists clinical practice guidelines for the treatment of schizophrenia and related disorders

Royal Australian And New Zealand College Of Psychiatrists Clinical Practice Guidelines Team For The Treatment Of Schizophrenia And Related Disorders·2005·Australian & New Zealand Journal of Psychiatry
DOI 10.1080/j.1440-1614.2005.01516.x
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Abstract

Background: The Royal Australian and New Zealand College of Psychiatrists is coordinating the development of clinical practice guidelines (CPGs) in psychiatry, funded under the National Mental Health Strategy (Australia) and the New Zealand Health Funding Authority. This paper presents CPGs for schizophrenia and related disorders. Over the past decade schizophrenia has become more treatable than ever before. A new generation of drug therapies, a renaissance of psychological and psychosocial interventions and a first generation of reform within the specialist mental health system have combined to create an evidence-based climate of realistic optimism. Progressive neuroscientific advances hold out the strong possibility of more definitive biological treatments in the near future. However, this improved potential for better outcomes and quality of life for people with schizophrenia has not been translated into reality in Australia. The efficacy-effectiveness gap is wider for schizophrenia than any other serious medical disorder. Therapeutic nihilism, under-resourcing of services and a stalling of the service reform process, poor morale within specialist mental health services, a lack of broad-based recovery and life support programs, and a climate of tenacious stigma and consequent lack of concern for people with schizophrenia are the contributory causes for this failure to effectively treat. These guidelines therefore tackle only one element in the endeavour to reduce the impact of schizophrenia. They distil the current evidence-base and make recommendations based on the best available knowledge. Method: A comprehensive literature review (1990–2003) was conducted, including all Cochrane schizophrenia reviews and all relevant meta-analyses, and a number of recent international clinical practice guidelines were consulted. A series of drafts were refined by the expert committee and enhanced through a bi-national consultation process. Treatment recommendations: This guideline provides evidence-based recommendations for the management of schizophrenia by treatment type and by phase of illness. The essential features of the guidelines are: (i) Early detection and comprehensive treatment of first episode cases is a priority since the psychosocial and possibly the biological impact of illness can be minimized and outcome improved. An optimistic attitude on the part of health professionals is an essential ingredient from the outset and across all phases of illness. (ii) Comprehensive and sustained intervention should be assured during the initial 3–5 years following diagnosis since course of illness is strongly influenced by what occurs in this ‘critical period’. Patients should not have to ‘prove chronicity’ before they gain consistent access and tenure to specialist mental health services. (iii) Antipsychotic medication is the cornerstone of treatment. These medicines have improved in quality and tolerability, yet should be used cautiously and in a more targeted manner than in the past. The treatment of choice for most patients is now the novel antipsychotic medications because of their superior tolerability and, in particular, the reduced risk of tardive dyskinesia. This is particularly so for the first episode patient where, due to superior tolerability, novel agents are the first, second and third line choice. These novel agents are nevertheless associated with potentially serious medium to long-term side-effects of their own for which patients must be carefully monitored. Conventional antipsychotic medications in low dosage may still have a role in a small proportion of patients, where there has been full remission and good tolerability; however, the indications are shrinking progressively. These principles are now accepted in most developed countries. (vi) Clozapine should be used early in the course, as soon as treatment resistance to at leasttwo antipsychotics has been demonstrated. This usually means incomplete remission of positive symptomatology, but clozapine may also be considered where there are pervasive negative symptoms or significant or persistent suicidal risk is present. (v) Comprehensive psychosocial interventions should be routinely available to all patients and their families, and provided by appropriately trained mental health professionals with time to devote to the task. This includes family interventions, cognitive-behaviour therapy, vocational rehabilitation and other forms of therapy, especially for comorbid conditions, such as substance abuse, depression and anxiety. (vi) The social and cultural environment of people with schizophrenia is an essential arena for intervention. Adequate shelter, financial security, access to meaningful social roles and availability of social support are essential components of recovery and quality of life. (vii) Interventions should be carefully tailored to phase and stage of illness, and to gender and cultural background. (viii) Genuine involvement of consumers and relatives in service development and provision should be standard. (ix) Maintenance of good physical health and prevention and early treatment of serious medical illness has been seriously neglected in the management of schizophrenia, and results in premature death and widespread morbidity. Quality of medical care for people with schizophrenia should be equivalent to the general community standard. (x) General practitioners (GPs)s should always be closely involved in the care of people with schizophrenia. However, this should be truly shared care, and sole care by a GP with minimal or no specialist involvement, while very common, is not regarded as an acceptable standard of care. Optimal treatment of schizophrenia requires a multidisciplinary team approach with a consultant psychiatrist centrally involved.

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  • Family psychoeducation is recommended in clinical practice guidelines for psychotic disorders, especially schizophrenia, in various industrialised countries.

    “Family psychoeducation is recommended in clinical practice guidelines for psychotic disorders, most notably schizophrenia, in various industrialised countries (Canadian Psychiatric Association 2005;Galletly 2005;Kreyenbuhl 2010;NICE 2014).”

    From Family psychoeducation for people living with schizophrenia and their families (2018) · cites this paper as Galletly 2005

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Authors
Royal Australian And New Zealand College Of Psychiatrists Clinical Practice Guidelines Team For The Treatment Of Schizophrenia And Related Disorders
Corresponding author
Royal Australian And New Zealand College Of Psychiatrists Clinical Practice Guidelines Team For The Treatment Of Schizophrenia And Related Disorders
Venue
Australian & New Zealand Journal of Psychiatry
Publisher
SAGE Publications
Published
2005-01
Volume
39
Issue
1-2
Pages
1-30
ISSN
  • 0004-8674 (ISSN-L)
  • 1440-1614
DOI
10.1080/j.1440-1614.2005.01516.x
OpenAlex
W3115493962
Cited by
435
References
207
Citations by year
2026: 2 · 2025: 8 · 2024: 3 · 2023: 6 · 2022: 8 · 2021: 7 · 2020: 9 · 2019: 9 · 2018: 17 · 2017: 21 · 2016: 29 · 2015: 30 · 2014: 35 · 2013: 38 · 2012: 30
FWCI
15.44
Type
journal article
Language
en
Open access
closed
Licence
journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations
  • Australian & New Zealand Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
  • Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
Keywords
schizophrenia, antipsychotic drugs, first-episode psychosis, early intervention, psychosocial interventions, social skills training, cognitive behavioral therapy, relapse prevention, medication adherence, treatment-resistant schizophrenia, atypical antipsychotics, mental health service reform, efficacy-effectiveness gap, stigma, recovery programs, evidence-based treatment
MeSH terms
Australia, Combined Modality Therapy, Follow-Up Studies, Humans, New Zealand, Psychotic Disorders, Rehabilitation, Vocational, Schizophrenia, Schizophrenic Psychology, Socioenvironmental Therapy, Antipsychotic Agents, Evidence-Based Medicine, Early Diagnosis, Secondary Prevention

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