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. 2017 Sep;62(9):604-616.
doi: 10.1177/0706743717720448. Epub 2017 Jul 13.

Guidelines for the Pharmacotherapy of Schizophrenia in Adults

Gary Remington  1   2 , Donald Addington  3   4 , William Honer  5 , Zahinoor Ismail  4   6 , Thomas Raedler  7 , Michael Teehan  8
Affiliations

Guidelines for the Pharmacotherapy of Schizophrenia in Adults

Gary Remington et al. Can J Psychiatry. 2017 Sep.

Abstract

Objective: The present guidelines address the pharmacotherapy of schizophrenia in adults across different stages, phases, and symptom domains.

Method: Guidelines were developed using the ADAPTE process, which takes advantage of existing guidelines. Six guidelines were identified for adaptation, with recommendations extracted from each. For those specific to the pharmacotherapy of schizophrenia in adults, a working group selected between guidelines and recommendations to create an adapted guideline.

Results: Recommendations can be categorized into 6 areas that include 1) first-episode schizophrenia, 2) acute exacerbation, 3) relapse prevention and maintenance treatment, 4) treatment-resistant schizophrenia, 5) clozapine-resistant schizophrenia, and 6) specific symptom domains. For each category, recommendations are made based on the available evidence, which is discussed and linked to other established guidelines.

Conclusions: In most cases, evidence-based recommendations are made that can be used to guide current clinical treatment and decision making. Notably, however, there is a paucity of established evidence to guide treatment decision making in the case of clozapine-resistant schizophrenia, a subsample that represents a sizable proportion of those with schizophrenia.

Keywords: adult psychiatry; antipsychotics; clinical practice guideline; pharmacotherapy; schizophrenia; systematic review.

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Conflict of interest statement

Declaration of Conflicting Interests: The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Remington has served as a consultant for Neurocrine Biosciences and Synchroneuron, received research support from Novartis and external funding from the Canadian Institutes of Health Research (CIHR) as well as Research Hospital Fund – Canadian Foundation for Innovation (RHF-CFI). Dr. Addington has nothing to disclose. Dr. Honer has received personal fees from Eli Lilly, Lundbeck, Otsuka, and Roche, as well as served on an advisory board for In Silico (no fee). Dr. Ismail has received external funding from the Canadian Institutes of Health Research (CIHR), and personal fees from Janssen, Eli Lilly, Lundbeck, Otsuka, Pfizer, and Sunovion, in addition to the Ontario Brain Institute (CAN-BIND Study). Dr. Raedler has received funding from the Mathison Centre for Mental Health Research and Education, personal fees from Janssen, Allergan, Bristol-Myers Squibb, and Sunovion, as well as clinical trial support from Roche, Forum, Boehringer-Ingelheim, Purdue, and Shire. Dr. Teehan has nothing to disclose.

References

    1. Canadian Psychiatric Association. Clinical practice guidelines: treatment of schizophrenia. Can J Psychiatry. 2005;50(Suppl 1):1S–56S.
    1. ADAPTE. The ADAPTE process: resource toolkit for guideline adaptation. 2009. Version 2.0. Available from: http://www.g-i-n.net
    1. National Institute for Health and Care Excellence (NICE). Psychosis and schizophrenia in adults: treatment and management. London (UK): NICE; 2014. - PubMed
    1. National Collaborating Centre for Mental Health. Psychosis and schizophrenia in children and young people. Recognition and management. National Clinical Guideline Number 155 2013.
    1. National Collaborating Centre for Mental Health. Psychosis with coexisting substance misuse. Assessment and management in adults and young people. NICE Clinical Guideline 120 2011. Available from: http://www.guidance.nice.org.uk/org.uk/cg120 - PubMed

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