The treatment of schizophrenia: can we raise the standard of care?

Catts, Stanley Victor and O'Toole, Brian Ignatius (2016) The treatment of schizophrenia: can we raise the standard of care?. Australian and New Zealand Journal of Psychiatry, 50 12: 1128-1138. doi:10.1177/0004867416672725


Author Catts, Stanley Victor
O'Toole, Brian Ignatius
Title The treatment of schizophrenia: can we raise the standard of care?
Journal name Australian and New Zealand Journal of Psychiatry   Check publisher's open access policy
ISSN 1440-1614
0004-8674
Publication date 2016-11-07
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1177/0004867416672725
Open Access Status Not yet assessed
Volume 50
Issue 12
Start page 1128
End page 1138
Total pages 11
Place of publication London, United Kingdom
Publisher Sage Publications
Collection year 2017
Language eng
Formatted abstract
Objective: There is evidence that over time health outcomes of people with schizophrenia are deteriorating rather than improving both in terms of mortality rate and levels of morbidity, even in Australia where service resourcing is substantial. Our objective was to examine the evidence of whether poor outcomes reflect decreases in treatment effectiveness and, if so, what are the barriers to improving standards of care. This review will argue that the confidence of clinicians to diagnose schizophrenia early, and provide assertive and long-term care, may be being undermined by a series of controversies in the published literature and discrepancies in clinical practice guidelines.

Method: A critical review was conducted of the evidence regarding six issues of high clinical relevance to the treatment of schizophrenia formulated as questions: (1) Is schizophrenia a progressive disease? (2) Does relapse contribute to disease progression and treatment resistance? (3) When should the diagnosis of schizophrenia be made? (4) Should maintenance antipsychotic medication be discontinued in fully remitted first-episode patients? (5) Do antipsychotic medications cause deleterious reductions in cortical grey matter volumes? and (6) Are long-acting injectable antipsychotics more effective in reducing relapse rate compared to oral formulations?

Results: There is reliable evidence for schizophrenia being a progressive disease with emergent treatment resistance in most cases, that relapse contributes to this treatment resistance, that maintenance antipsychotic medication should not be discontinued in remitted first-episode patients, that antipsychotic medication does not appear to cause deleterious grey matter volume changes, that maintenance antipsychotic medication reduces the mortality rate in schizophrenia and that long-acting injectable antipsychotics are more effective in preventing relapse than oral formulations.

Conclusion: There is an urgent need to re-engineer the early management of schizophrenia and to routinely evaluate this type of innovation within practice-based research networks. A proposal for an assertive treatment algorithm is included.
Keyword Algorithm
Medication
Outcomes
Schizophrenia
Treatment
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Admin Only - School of Medicine
School of Medicine Publications
 
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