Schizophrenia

Abstract

Background: The lifetime prevalence of schizophrenia is 1%. Schizophrenia is among the most severe mental illnesses and gives rise to the highest treatment costs per patient of any disease. It is characterized by frequent relapses, marked impairment of quality of life, and reduced social and work participation.

Methods: The group entrusted with the creation of the German clinical practice guideline was chosen to be representative and pluralistic in its composition. It carried out a systematic review of the relevant literature up to March 2018 and identified a total of 13 389 publications, five source guidelines, three other relevant German clinical practice guidelines, and four reference guidelines.

Results: As the available antipsychotic drugs do not differ to any great extent in efficacy, it is recommended that acute antipsychotic drug therapy should be sideeffect- driven, with a number needed to treat (NNT) of 5 to 8. The choice of treatment should take motor, metabolic, sexual, cardiac, and hematopoietic considerations into account. Ongoing antipsychotic treatment is recommended to prevent relapses (NNT: 3) and should be re-evaluated on a regular basis in every case. It is also recommended, with recommendation grades ranging from strong to intermediate, that disorder- and manifestation-driven forms of psychotherapy and psychosocial therapy, such as cognitive behavioral therapy for positive or negative manifestations (effect sizes ranging from d = 0.372 to d = 0.437) or psycho-education to prevent relapses (NNT: 9), should be used in combination with antipsychotic drug treatment. Further aspects include rehabilitation, the management of special treatment situations, care coordination, and quality management. A large body of evidence is available to provide a basis for guideline recommendations, particularly in the areas of pharmacotherapy and cognitive behavioral therapy.

Conclusion: The evidence-based diagnosis and treatment of persons with schizophrenia should be carried out in a multiprofessional process, with close involvement of the affected persons and the people closest to them.

Figure

Treatment algorithm derived from the revised German clinical practice guidelines (focus on pharmacology): Here the guidelines’ essential treatment recommendations are summarized; for clinical application, however, it is vital to consult the long version of the guidelines and the detailed recommendations therein (this algorithm does not form part of the clinical practice guidelines). ADR, adverse drug reaction; TDM, therapeutic drug monitoring; TMS, transcranial magnetic stimulation

eFigure 1

Flow chart of systematic literature survey. The diagram summarizes the entire literature survey. The individual searches and the search terms used can be found in the guideline report (18) (this flow chart does not form part of the guidelines).

eFigure 2

Algorithms for psychopathological and somatic differential diagnosis (derived from, but not forming part of, the new German clinical practice guidelines)