Updated recommendations for schizophrenia treatment by APA

Assessment and Determination of Treatment Plan

• APA recommends that the initial assessment of a patient with a possible psychotic disorder include the reason the individual is presenting for evaluation; the patient's goals and preferences for treatment; a review of psychiatric symptoms and trauma history; an assessment of tobacco use and other substance use; a psychiatric treatment history; an assessment of physical health; an assessment of psychosocial and cultural factors; a mental status examination, including cognitive assessment; and an assessment of the risk of suicide and aggressive behaviors, as outlined in APA's Practice Guidelines for the Psychiatric Evaluation of Adults (3rd edition).
• APA recommends that the initial psychiatric evaluation of a patient with a possible psychotic disorder include a quantitative measure to identify and determine the severity of symptoms and impairments of functioning that may be a focus of treatment.
• APA recommends that patients with schizophrenia have a documented, comprehensive, and person-centered treatment plan that includes evidence-based nonpharmacological and pharmacological treatments.

Pharmacotherapy

• APA recommends that patients with schizophrenia be treated with antipsychotic medication and monitored for effectiveness and side effects.
• APA recommends that patients with schizophrenia whose symptoms have improved with an antipsychotic medication continue to be treated with antipsychotic medication.
• APA suggests that patients with schizophrenia whose symptoms have improved with an antipsychotic medication continue to be treated with the same antipsychotic medication.
• APA recommends that patients with treatment-resistant schizophrenia be treated with clozapine.
• APA recommends that patients with schizophrenia be treated with clozapine if the risk for suicide attempts or suicide remains substantial despite other treatments.
• APA suggests that patients with schizophrenia be treated with clozapine if the risk for aggressive behavior remains substantial despite other treatments.
• APA suggests that patients receive treatment with a long-acting injectable antipsychotic medication if they prefer such treatment or if they have a history of poor or uncertain adherence.
• APA recommends that patients who have acute dystonia associated with antipsychotic therapy be treated with anticholinergic medication.
• APA suggests the following options for patients who have parkinsonism associated with antipsychotic therapy: lowering the dosage of the antipsychotic medication, switching to another antipsychotic medication, or treating with anticholinergic medication.
• APA suggests the following options for patients who have akathisia associated with antipsychotic therapy: lowering the dosage of the antipsychotic medication, switching to another antipsychotic medication, adding a benzodiazepine medication, or adding a beta-adrenergic blocking agent.
• APA recommends that patients who have moderate to severe or disabling tardive dyskinesia associated with antipsychotic therapy be treated with a reversible inhibitor of the vesicular monoamine transporter 2 (VMAT2).

Psychosocial Intervention

• APA recommends that patients with schizophrenia who are experiencing the first episode of psychosis be treated in a coordinated specialty care program.
• APA recommends that patients with schizophrenia be treated with cognitive-behavioral therapy for psychosis (CBTp).
• APA recommends that patients with schizophrenia receive psychoeducation.
• APA recommends that patients with schizophrenia receive supported employment services.
• APA recommends that patients with schizophrenia receive assertive community treatment if there is a history of poor engagement with services leading to frequent relapse or social disruption (e.g. homelessness; legal difficulties, including imprisonment).
• APA suggests that patients with schizophrenia who have ongoing contact with family receive family interventions.
• APA suggests that patients with schizophrenia receive interventions aimed at developing self-management skills and enhancing person-oriented recovery.
• APA suggests that patients with schizophrenia receive cognitive remediation.
• APA suggests that patients with schizophrenia who have a therapeutic goal of enhanced social functioning receive social skills training.
• APA suggests that patients with schizophrenia be treated with supportive psychotherapy.