First update in 16 years provides evidence-based recommendations vetted by 13 experts
UMass Medical School neuropsychiatry expert and educator Sheldon Benjamin, MD, is an invited co-author of the new American Psychiatric Association Practice Guidelines for the Treatment of Patients with Schizophrenia. The first update of the publication in 16 years provides evidence-based recommendations vetted by 13 experts to reduce the mortality, morbidity and significant psychosocial and health consequences of the illness, one of the top 20 causes of disability worldwide.
“I was honored to be asked as a neurologist/psychiatrist to contribute. Living with schizophrenia is terribly difficult,” said Dr. Benjamin, interim chair and professor of psychiatry and professor of neurology. “We hope the publication of the new guidelines will focus greater attention on the needs of this population.”
Published online and in print, the 336-page volume was cowritten by a 13-member work group with diverse expertise. They systematically evaluated the extensive current body of relevant literature and reached agreement on each statement. Twenty-four recommendations address patient assessment and treatment planning, pharmacotherapy and psychosocial interventions.
Replacing the previous practice guideline released in 2004, it is also the first APA guideline for an entire disorder that uses standards set forth by the Institute of Medicine in 2011 to ensure clinical guidelines meet high standards of transparency and scientific rigor.
The guideline recommends that patients with schizophrenia have a documented, comprehensive, and person-centered treatment plan that includes evidence-based nonpharmacological and pharmacological treatments. In addition to reaffirming that patients diagnosed with schizophrenia should be treated with an antipsychotic medication and that patients whose symptoms improve while taking an antipsychotic medication should continue the treatment, the new edition further recommends or suggests several treatment options for side effects associated with these medications.
Psychosocial interventions are strongly recommended, including cognitive-behavioral therapy for psychosis, education about schizophrenia, and supported employment services.
All the outlined recommendations “should be made in collaboration with the patient, whenever possible, and should incorporate the patient’s personal and sociocultural preferences and values in order to enhance the therapeutic alliance, adherence to treatment, and treatment outcomes,” the work group wrote.
“Although the neuroscience is rapidly evolving, a definitive treatment remains elusive as of 2020,” said Benjamin. “We can, however, do much to minimize symptoms, manage side effects and provide evidence-based support to patients and families dealing with this problem, and our guidelines provide the best evidence available.”
An executive summary of the guideline is published in the American Journal of Psychiatry. The full guideline and related materials are on the APA website.