npj Schizophrenia (Feb 2022)

Systematic literature review of schizophrenia clinical practice guidelines on acute and maintenance management with antipsychotics

  • Christoph U. Correll,
  • Amber Martin,
  • Charmi Patel,
  • Carmela Benson,
  • Rebecca Goulding,
  • Jennifer Kern-Sliwa,
  • Kruti Joshi,
  • Emma Schiller,
  • Edward Kim

DOI
https://doi.org/10.1038/s41537-021-00192-x
Journal volume & issue
Vol. 8, no. 1
pp. 1 – 10

Abstract

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Abstract Clinical practice guidelines (CPGs) translate evidence into recommendations to improve patient care and outcomes. To provide an overview of schizophrenia CPGs, we conducted a systematic literature review of English-language CPGs and synthesized current recommendations for the acute and maintenance management with antipsychotics. Searches for schizophrenia CPGs were conducted in MEDLINE/Embase from 1/1/2004–12/19/2019 and in guideline websites until 06/01/2020. Of 19 CPGs, 17 (89.5%) commented on first-episode schizophrenia (FES), with all recommending antipsychotic monotherapy, but without agreement on preferred antipsychotic. Of 18 CPGs commenting on maintenance therapy, 10 (55.6%) made no recommendations on the appropriate maximum duration of maintenance therapy, noting instead individualization of care. Eighteen (94.7%) CPGs commented on long-acting injectable antipsychotics (LAIs), mainly in cases of nonadherence (77.8%), maintenance care (72.2%), or patient preference (66.7%), with 5 (27.8%) CPGs recommending LAIs for FES. For treatment-resistant schizophrenia, 15/15 CPGs recommended clozapine. Only 7/19 (38.8%) CPGs included a treatment algorithm.