Excerpt

The guideline makes recommendations for the treatment and management of schizophrenia. It aims to improve access and engagement with treatment and services for people with schizophrenia; evaluate the role of specific psychological and psychosocial interventions in the treatment of schizophrenia; evaluate the role of specific pharmacological interventions in the treatment of schizophrenia; evaluate the role of specific service level interventions for people with schizophrenia; integrate the above to provide best-practice advice on the care of people with schizophrenia and their family and carers; and promote the implementation of best clinical practice through the development of recommendations tailored to the requirements of the NHS in England and Wales.

Contents

• Guideline Development Group members
• Acknowledgements
• 1. Preface
  • 1.1 National guideline
  • 1.2 The national schizophrenia guideline
• 2. Schizophrenia
  • 2.1 The disorder
  • 2.2 Incidence and prevalence
  • 2.3 Possible causes of schizophrenia
  • 2.4 Assessment
  • 2.5 Engagement, consent and therapeutic alliance
  • 2.6 Language and stigma
  • 2.7 Issues for families and carers
  • 2.8 Treatment and management of schizophrenia in the NHS
  • 2.9 The economic cost of schizophrenia
• 3. Methods used to update this guideline
  • 3.1 Overview
  • 3.2 The scope
  • 3.3 The Guideline Development Group
  • 3.4 Clinical questions
  • 3.5 Systematic clinical literature review
  • 3.6 Health economics methods
  • 3.7 Stakeholder contributions
  • 3.8 Validation of the guideline
• 4. Experience of care
  • 4.1 Introduction
  • 4.2 Methodology
  • 4.3 Personal accounts from people with schizophrenia
  • 4.4 Personal accounts from carers
  • 4.5 Summary of themes from the personal accounts
  • 4.6 Recommendations
• 5. Access and engagement
  • 5.1 Introduction
  • 5.2 Early intervention
  • 5.3 Access and engagement to service-level interventions
• 6. Pharmacological interventions in the treatment and management of schizophrenia
  • 6.1 Introduction
  • 6.2 Initial treatment with antipsychotic medication
  • 6.3 Oral antipsychotics in the treatment of the acute episode
  • 6.4 Promoting recovery in people with schizophrenia that is in remission – pharmacological relapse prevention
  • 6.5 Promoting recovery in people with schizophrenia whose illness has not responded adequately to treatment
  • 6.6 Treatment with depot/long-acting injectable antipsychotic medication
  • 6.7 Side effects of antipsychotic medication
  • 6.8 Effectiveness of antipsychotic medication
  • 6.9 Health economics
  • 6.10 From evidence to recommendations
  • 6.11 Recommendations
• 7. Economic model – cost effectiveness of pharmacological interventions for people with schizophrenia
  • 7.1 Introduction
  • 7.2 Economic modelling methods
  • 7.3 Results
  • 7.4 Discussion of findings - limitations of the analysis
  • 7.5 Conclusions
• 8. Psychological therapy and psychosocial interventions in the treatment and management of schizophrenia
  • 8.1 Introduction
  • 8.2 Adherence therapy
  • 8.3 Arts therapies
  • 8.4 Cognitive–behavioural therapy
  • 8.5 Cognitive remediation
  • 8.6 Counselling and supportive therapy
  • 8.7 Family intervention
  • 8.8 Psychodynamic and Psychoanalytic therapies
  • 8.9 Psychoeducation
  • 8.10 Social skills training
  • 8.11 Recommendations (across all treatments)
• 9. Service-level interventions in the treatment and management of schizophrenia
  • 9.1 Introduction
  • 9.2 Interface between primary and secondary care
  • 9.3 Community mental health teams
  • 9.4 Assertive outreach (assertive community treatment)
  • 9.5 Acute day hospital care
  • 9.6 Vocational rehabilitation
  • 9.7 Non-acute day hospital care
  • 9.8 Crisis resolution and home treatment teams
  • 9.9 Intensive case management
• 10. Clinical evidence summary tables
  • 10.2 Abbreviations
  • 10.3 Early intervention services
  • 10.4 Access and Engagament to service level interventions
  • Pharmacological interventions in the treatment and management of schizophrenia
  • 10.5 Psychological therapy and psychosocial interventions
• 11. Summary of recommendations
  • 11.1 Care across all phases
  • 11.2 Initiation of treatment (first episode)
  • 11.3 Treatment of the acute episode
  • 11.4 Promoting recovery
  • 11.5 Research Recommendations
• Appendix 1 Scope for the development of the clinical guideline
• Appendix 2 Declarations of interests by GDG members
• Appendix 3 Special advisors to the Guideline Development Group
• Appendix 4 Stakeholders and experts who submitted comments in response to the consultation draft of the guideline
• Appendix 5 Researchers contacted to request information about unpublished or soon-to-be published studies
• Appendix 6 Analytic framework and clinical questions
• Appendix 7 Clinical review protocol template
• Appendix 8 Search strategies for the identification of clinical studies
• Appendix 9 Quality checklists for clinical studies and reviews
• Appendix 10 Search strategies for the identification of health economics evidence
• Appendix 11 Quality checklist for economic studies
• Appendix 12 Data extraction form for economic studies
• Appendix 13 Winbugs codes used for Mixed Treatment Comparisons in the economic model of pharmacological treatments for relapse prevention
• Appendix 14 Evidence tables for economic studies
• Appendix 15 Study characteristics tables
• Appendix 16 Clinical evidence forest plots
• Appendix 17 Previous guideline methodology
• References