Schizophrenia Guidelines

Updated: Jul 26, 2021
  • Author: Frances R Frankenburg, MD; Chief Editor: Glen L Xiong, MD  more...
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Guidelines

Guidelines Summary

American Psychiatric Association (APA)

The American Psychiatric Association (APA) released the third edition of its Practice Guideline for the Treatment of Patients with Schizophrenia in 2020. [134] Recommendations address treatment planning, pharmacotherapy, and psychosocial interventions. Some of these recommendations are listed below. 

Assessment and determination of treatment plan

The APA recommends a thorough initial assessment that includes the following components:

  • Reason patient is presenting

  • Patient's goals/preferences for treatment

  • Psychiatric symptoms

  • Trauma history

  • Tobacco/substance use

  • Psychiatric treatment history

  • Physical health

  • Mental status/cognitive assessment

  • Suicidality

  • Aggressive behaviors

The APA also recommends an initial psychiatric evaluation and a documented, comprehensive, and person-centered treatment plan.

Pharmacotherapy

The APA recommends treating schizophrenic patients with antipsychotic medication and monitoring effectiveness and side effects. If a patient's symptoms improve with antipsychotics, the APA recommends continuing the same medication. 

The APA recommends that treatment-resistant patients be treated with clozapine. This recommendation also applies to patients at substantial risk of suicide or suicide attempts as well as those at substantial risk of aggressive behavior despite other treatments.

The APA recommends that patients with acute dystonia associated with antipsychotic therapy be treated with an anticholinergic medication. 

Psychosocial interventions

The APA recommends patients with schizophrenia be treated with cognitive-behavioral therapy for psychosis and receive psychoeducation, supported employment services, social skills training, and cognitive remediation, among other services.