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Schizophrenia

Schizophrenia

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apa guidelines
apa guidelines

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Published by: grinakis on Aug 02, 2010
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1
PRACTICE GUIDELINE FOR THE
 Treatment of Patients WithSchizophrenia
Second Edition
WORK GROUP ON SCHIZOPHRENIA
 Anthony F. Lehman, M.D., M.S.P.H., Chair Jeffrey A. Lieberman, M.D., Vice-ChairLisa B. Dixon, M.D., M.P.H.Thomas H. McGlashan, M.D. Alexander L. Miller, M.D.Diana O. Perkins, M.D., M.P.H. Julie Kreyenbuhl, Pharm.D., Ph.D. (Consultant)
Originally published in February 2004. A guideline watch, summarizing significant developments in the scientific literature since publication of this  guideline, may be available in the Psychiatric Practice section of the APAweb site at www.psych.org.
 
2
APA Practice Guidelines 
AMERICAN PSYCHIATRIC ASSOCIATIONSTEERING COMMITTEE ON PRACTICE GUIDELINES
 John S. McIntyre, M.D.,
Chair 
Sara C. Charles, M.D.,
Vice-Chair 
Daniel J. Anzia, M.D.Ian A. Cook, M.D.Molly T. Finnerty, M.D.Bradley R. Johnson, M.D. James E. Nininger, M.D.Paul Summergrad, M.D.Sherwyn M. Woods, M.D., Ph.D. Joel Yager, M.D.
AREA AND COMPONENT LIAISONS
Robert Pyles, M.D. (Area I)C. Deborah Cross, M.D. (Area II)Roger Peele, M.D. (Area III)Daniel J. Anzia, M.D. (Area IV) John P. D. Shemo, M.D. (Area V)Lawrence Lurie, M.D. (Area VI)R. Dale Walker, M.D. (Area VII)Mary Ann Barnovitz, M.D.Sheila Hafter Gray, M.D.Sunil Saxena, M.D.Tina Tonnu, M.D.
STAFF
Robert Kunkle, M.A.,
Senior Program Manager 
 Amy B. Albert, B.A.,
 Assistant Project Manager 
Laura J. Fochtmann, M.D.,
 Medical Editor 
Claudia Hart,
Director, Department of Quality Improvement and Psychiatric Services 
Darrel A. Regier, M.D., M.P.H.,
Director, Division of Research
 
Treatment of Patients With Schizophrenia 
3
CONTENTS
Statement of Intent. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Guide to Using This Practice Guideline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Development Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Part A: Treatment Recommendations for PatientsWith Schizophrenia
. . . . . . . . . . . . . . . . . . 9I.Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9A.Coding System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9B.Formulation and Implementation of a Treatment Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9C.Establishing a Therapeutic Alliance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10D.Acute Phase Treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10E.Stabilization Phase. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12F.Stable Phase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12G.Other Specific Treatment Issues. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14H.Treatment Settings and Housing Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16II.Formulation and Implementation of a Treatment Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17A.Psychiatric Management. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17B.Acute Phase. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22C.Stabilization Phase. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33D.Stable Phase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34E.Special Issues in Caring for Patients With Treatment-Resistant Illness . . . . . . . . . . . . . . . . . 39F.Clinical Features Influencing the Treatment Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40III.Treatment Settings and Housing Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54A.Choice of Treatment Setting or Housing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54B.Common Treatment Settings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
Part B: Background Information and Review of Available Evidence
. . . . . . . . . . . . . . . . . . . 61IV.Disease Definition, Natural History and Course, and Epidemiology. . . . . . . . . . . . . . . . . . . . . . . 61A.Clinical Features. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61B.Natural History and Course. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63C.Epidemiology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64V.Review and Synthesis of Available Evidence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66A.Pharmacological Treatments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66B.Other Somatic Therapies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101C.Specific Psychosocial Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
Part C: Future Research Directions
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114Individuals and Organizations That Submitted Comments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116

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