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The American Psychiatric Association Practice Guideline for the Treatment of Patients with Schizophrenia Third Edition

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The American Psychiatric Association Practice Guideline for the Treatment of Patients with Schizophrenia Third Edition THE AMERICAN PSYCHIATRIC ASSOCIATION PRACTICE GUIDELINE FOR THE TREATMENT OF PATIENTS WITH SCHIZOPHRENIA PRACTICE GUIDELINE ASSOCIATION THE OF FOR PATIENTS TREATMENT THE AMERICAN PSYCHIATRIC THE AMERICAN PSYCHIATRIC ASSOCIATION PRACTICE GUIDELINE he American Psychiatric Association Practice Guideline for the Treat- ment of Patients With Schizophrenia seeks to reduce the substantial FOR THE T psychosocial and public health consequences for individuals affect- ed by schizophrenia. The guideline focuses speciÿcally on evidence-based pharmacological and nonpharmacological treatments for schizophrenia Treatment of Patients and includes statements related to assessment and treatment planning, which are an integral part of patient-centered care. The guideline provides With Schizophrenia direction on implementing these recommendations into clinical practice, with the goal of improving the quality of care and treatment outcomes for patients with schizophrenia. THIRD EDITION THIRD EDITION Cover design: Tammy J. Cordova THE AMERICAN PSYCHIATRIC ASSOCIATION PRACTICE GUIDELINE FOR THE Treatment of Patients With Schizophrenia THIRD EDITION Guideline Writing Group George A. Keepers, M.D., Chair Laura J. Fochtmann, M.D., M.B.I., Vice-Chair; Methodologist Joan M. Anzia, M.D. Sheldon Benjamin, M.D. Jeffrey M. Lyness, M.D. Ramin Mojtabai, M.D. Mark Servis, M.D. Art Walaszek, M.D. Peter Buckley, M.D. Mark F. Lenzenweger, Ph.D. Alexander S. Young, M.D., M.S.H.S. Amanda Degenhardt, M.D. Systematic Review Group Laura J. Fochtmann, M.D., M.B.I., Methodologist Seung-Hee Hong Committee on Practice Guidelines Daniel J. Anzia, M.D., Chair R. Scott Benson, M.D. Thomas J. Craig, M.D. Catherine Crone, M.D. Annette L. Hanson, M.D. John M. Oldham, M.D. Carlos N. Pato, M.D., Ph.D. Michael J. Vergare, M.D. Joel Yager, M.D., Consultant Laura J. Fochtmann, M.D., M.B.I., Consultant APA Assembly Liaisons Daniel Dahl, M.D. Bhasker Dave, M.D. Evan Eyler, M.D. Annette L. Hanson, M.D. Jason W. Hunziker, M.D. Marvin Koss, M.D. Robert M. McCarron, D.O. John P.D. Shemo, M.D. APA wishes to acknowledge the contributions of APA staff and former staff (Jennifer Medicus, Seung-Hee Hong, Samantha Shugarman, Michelle Dirst, Kristin Kroeger Ptakowski). APA also wishes to acknowledge the contribution of Amanda S. Eloma, Pharm.D., BCPP, in reviewing information related to medications in the guideline and associated tables. In addition, APA and the Guideline Writing Group especially thank Laura J. Fochtmann, M.D., M.B.I.; Seung-Hee Hong; and Jennifer Medicus for their outstanding work and effort in developing this guideline. APA also thanks the APA Committee on Practice Guidelines (Daniel J. Anzia, M.D., Chair), liaisons from the APA Assembly for their input and assistance, and APA Councils and others for providing feedback during the comment period. The authors have worked to ensure that all information in this book is accurate at the time of publication and consistent with general psychiatric and medical standards. As medical research and practice continue to ad- vance, however, therapeutic standards may change. Moreover, specific situations may require a specific ther- apeutic response not included in this book. For these reasons and because human and mechanical errors sometimes occur, we recommend that readers follow the advice of physicians directly involved in their care or the care of a member of their family. For inquiries about permissions or licensing, please contact Permissions & Licensing, American Psychiatric Association Publishing, 800 Maine Avenue SW, Suite 900, Washington, DC 20024-2812 or submit inquiries on- line at: www.appi.org/Support/Customer-Information/Permissions. If you wish to buy 50 or more copies of the same title, please go to www.appi.org/specialdiscounts for more information. Copyright © 2021 American Psychiatric Association ALL RIGHTS RESERVED Third Edition Manufactured in the United States of America on acid-free paper 2423222120 54321 American Psychiatric Association 800 Maine Avenue SW Suite 900 Washington, DC 20024-2812 www.appi.org Library of Congress Cataloging-in-Publication Data Names: American Psychiatric Association, author, issuing body. Title: The American Psychiatric Association practice guideline for the treatment of patients with schizophrenia / Guideline Writing Group, Systematic Review Group, Committee on Practice Guidelines. Other titles: Treatment of patients with schizophrenia Description: Third edition. | Washington, DC : American Psychiatric Association, [2021] | Preceded by: Practice guideline for the treatment of patients with schizophrenia. 2nd ed. c2004. | Includes bibliographical references. Identifiers: LCCN 2020016573 (print) | LCCN 2020016574 (ebook) | ISBN 9780890424698 (paperback ; alk. paper) | ISBN 9780890424742 (ebook) Subjects: MESH: Schizophrenia—therapy | Practice Guideline Classification: LCC RC514 (print) | LCC RC514 (ebook) | NLM WM 203 | DDC 616.89/8—dc23 LC record available at https://lccn.loc.gov/2020016573 LC ebook record available at https://lccn.loc.gov/2020016574 British Library Cataloguing in Publication Data A CIP record is available from the British Library. Contents Acronyms/Abbreviations . xi Introduction . 1 Rationale . 1 Scope of Document . 2 Overview of the Development Process . 2 Rating the Strengths of Guideline Statements and Supporting Research Evidence . 3 Proper Use of Guidelines . 4 Guideline Statement Summary . 5 Guideline Statements and Implementation . 7 Assessment and Determination of Treatment Plan . 7 Statement 1: Assessment of Possible Schizophrenia . 7 Implementation . .7 Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement . .16 Review of Available Guidelines From Other Organizations . .17 Quality Measurement Considerations . .17 Statement 2: Use of Quantitative Measures . 18 Implementation . .18 Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement . .20 Review of Available Guidelines From Other Organizations . .22 Quality Measurement Considerations . .22 Statement 3: Evidence-Based Treatment Planning . 23 Implementation . .23 Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement . .32 Review of Available Guidelines From Other Organizations . 33 Quality Measurement Considerations . 33 Pharmacotherapy . 33 Statement 4: Antipsychotic Medications . 33 Implementation. 34 Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement . 80 Review of Available Guidelines From Other Organizations . 81 Quality Measurement Considerations . 82 Statement 5: Continuing Medications. 83 Implementation. 83 Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement . 84 Review of Available Guidelines From Other Organizations . 85 Quality Measurement Considerations . 85 Statement 6: Continuing the Same Medications. 85 Implementation. 85 Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement . 87 Review of Available Guidelines From Other Organizations . 87 Quality Measurement Considerations . 87 Statement 7: Clozapine in Treatment-Resistant Schizophrenia . 88 Implementation. 88 Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement . 95 Review of Available Guidelines From Other Organizations . 96 Quality Measurement Considerations . 96 Statement 8: Clozapine in Suicide Risk . 97 Implementation. 97 Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement . 97 Review of Available Guidelines From Other Organizations . 98 Quality Measurement Considerations . 98 Statement 9: Clozapine in Aggressive Behavior . 99 Implementation . .99 Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement . .99 Review of Available Guidelines From Other Organizations . .100 Quality Measurement Considerations . .101 Statement 10: Long-Acting Injectable Antipsychotic Medications. 101 Implementation . .101 Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement . .103 Review of Available Guidelines From Other Organizations . .104 Quality Measurement Considerations . .104 Statement 11: Anticholinergic Medications for Acute Dystonia . 104 Implementation . .104 Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement . .106 Review of Available Guidelines From Other Organizations . .106 Quality Measurement Considerations . .107 Statement 12: Treatments for Parkinsonism. 107 Implementation . .107 Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement . .108 Review of Available Guidelines From Other Organizations . .111 Quality Measurement Considerations . .111 Statement 13: Treatments for Akathisia . 111 Implementation . .111 Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement . .112 Review of Available Guidelines From Other Organizations . .113 Quality Measurement Considerations . .113 Statement 14: VMAT2 Medications for Tardive Dyskinesia . 113 Implementation . .113 Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement . 117 Review of Available Guidelines From Other Organizations . 118 Quality Measurement Considerations . 118 Psychosocial Interventions. 119 Statement 15: Coordinated Specialty Care Programs . 119 Implementation. 119 Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement . 119 Review of Available Guidelines From Other Organizations . 120 Quality Measurement Considerations . 120 Statement 16: Cognitive-Behavioral Therapy . 120 Implementation. 121 Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement . 122 Review of Available Guidelines From Other Organizations . 122 Quality Measurement Considerations . 123 Statement 17: Psychoeducation . ..
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