American Psychiatric Association (APA) Recommendations for the Management of Schizophrenia

Assessment

1. The initial assessment of a patient with a possible psychotic disorder includes 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).
2. The initial psychiatric evaluation of a patient with a possible psychotic disorder includes a quantitative measure to identify and determine the severity of symptoms and impairments of functioning that may be a focus of treatment.
3. patients with schizophrenia have a documented, comprehensive, and person-centered treatment plan that includes evidence-based nonpharmacological and pharmacological treatments.

Pharmacotherapy

APA recommends treating patients with schizophrenia with antipsychotic medication and monitoring for effectiveness and side effects.

4. Patients who improve with an antipsychotic medication continue the same agent. *
5. APA recommends clozapine for patients with treatment-resistant schizophrenia or those with high-risk for suicide attempts, suicide, OR aggressive behavior remains substantial despite other treatments
6. For a patient who prefers, or has a history of poor or uncertain adherence, the APA recommends a long-acting injectable antipsychotic medication.  
7. For a patient who has acute dystonia associated with antipsychotic therapy, use anticholinergic medication.

Parkinsonism

The following options for patients who have parkinsonism associated with antipsychotic therapy: 

• Cutting the dose of the antipsychotic medication, 
• Switching to another antipsychotic, or 
• Anticholinergic medication.

Akathisia

The following options for patients who have akathisia associated with antipsychotic therapy: 

• Lowering the dose of the medication, 
• Switching to another antipsychotic, 
• Adding a benzodiazepine, or 
• Adding a beta-adrenergic blocking agent.
   

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).

* Implemented in a person-centered treatment plan that incorporates evidence-based nonpharmacological and pharmacological treatments for schizophrenia.

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