New Guidelines for Schizophrenia

Table of Contents

. The new guidelines recommend a trial of clozapine after failure (< 20% response after 6 weeks) of two antipsychotics. Unlike the 2004 guidelines, they no longer require a trial of a first generation antipsychotic. Clozapine is also recommended for patients with suicidality, problematic aggression, and tardive dyskinesia.

Blood levels boosted. The guidelines make a stronger recommendation about using antipsychotic blood levels to determine adherence. At least one blood level should be checked before moving to clozapine to ensure that the treatment failures were not due to non-adherence. While blood levels tell us if the patient is taking the med, they are not a reliable guide to dosing except in the case of clozapine, whose therapeutic effects are greatest at > 350 ng/mL.

Psychosocial therapies move up. In a striking change, the guidelines recommend that all first-episode patients be treated in a coordinated specialty care program. These teams incorporate medication treatment with education, resiliency training, family therapy, and vocational rehabilitation. After the first episode, psychosocial therapies should be customized to match the patients goals, and the guide lists ten therapies with links to free training manuals.

The full guide includes useful antipsychotic charts, strategies for side effect management (with metformin first-line for weight gain), and links to free rating scales on the APA website. The link to the guidelines is in our episode notes.

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