THE AMERICAN PSYCHIATRIC ASSOCIATION PRACTICE …

1 This guideline is undergoing copyediting and the final version is expected to be released summer 2020. THE AMERICAN PSYCHIATRIC ASSOCIATION PRACTICE GUIDELINE FOR THE TREATMENT OF PATIENTS WITH SCHIZOPHRENIA Guideline Writing Group George A. Keepers, (Chair) Laura J. Fochtmann, , (Vice-Chair; Methodologist) Joan M. Anzia, Sheldon Benjamin, Jeffrey M. Lyness, Ramin Mojtabai, Mark Servis, Art Walaszek, Peter Buckley, Mark F. Lenzenweger, Alexander S. Young, , Amanda Degenhardt, Systematic Review Group Laura J.

2 Fochtmann, , (Methodologist) Seung-Hee Hong Committee on PRACTICE Guidelines Daniel J. Anzia, (Chair) R. Scott Benson, Thomas J. Craig, Catherine Crone, Annette L. Hanson, John M. Oldham, Carlos N. Pato, , Michael J. Vergare, Joel Yager, (Consultant) Laura J. Fochtmann, , (Consultant) APA Assembly Liaisons Daniel Dahl, Bhasker Dave, Evan Eyler, Annette L. Hanson, Jason W. Hunziker, Marvin Koss, Robert M. McCarron, John Shemo, Acknowledgements APA wishes to acknowledge the contributions of APA staff (Jennifer Medicus, Seung-Hee Hong, Samantha Shugarman, Michelle Dirst, Kristin Kroeger Ptakowski).

3 APA also wishes to acknowledge the contribution of Amanda S. Eloma, , 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, , , 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, 2 , Chair), liaisons from the APA Assembly for their input and assistance, and APA Councils and others for providing feedback during the comment period.

4 3 Table of Contents Guideline Writing Group .. 1 Systematic Review Group .. 1 Committee on PRACTICE Guidelines .. 1 APA Assembly Liaisons .. 1 Acknowledgements .. 1 Table of Contents .. 3 Acronyms/Abbreviations .. 10 Introduction .. 12 Rationale .. 12 Scope of Document .. 13 Overview of the Development Process .. 14 Rating the Strengths of Guideline Statements and Supporting Research Evidence .. 14 Proper Use of Guidelines .. 15 Guideline Statement Summary .. 16 Guideline Statements and Implementation .. 18 Assessment and Determination of Treatment Plan.

5 18 Statement 1: Assessment of Possible Schizophrenia .. 18 Implementation .. 18 Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement .. 31 Review of Available Guidelines from Other Organizations .. 32 Quality Measurement Considerations .. 32 Statement 2: Use of Quantitative Measures .. 33 Implementation .. 33 Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement .. 36 Review of Available Guidelines from Other Organizations .. 38 Quality Measurement Considerations.

6 38 Statement 3: Evidence-based Treatment Planning .. 39 Implementation .. 39 4 Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement .. 50 Review of Available Guidelines from Other Organizations .. 51 Quality Measurement Considerations .. 51 Pharmacotherapy .. 52 Statement 4: Antipsychotic Medications .. 52 Implementation .. 52 Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement .. 110 Review of Available Guidelines from Other Organizations .. 111 Quality Measurement Considerations.

7 112 Statement 5: Continuing Medications .. 113 Implementation .. 113 Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement .. 115 Review of Available Guidelines from Other Organizations .. 116 Quality Measurement Considerations .. 116 Statement 6: Continuing the Same Medications .. 116 Implementation .. 116 Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement .. 118 Review of Available Guidelines from Other Organizations .. 118 Quality Measurement Considerations.

8 119 Statement 7: Clozapine in Treatment-resistant Schizophrenia .. 119 Implementation .. 119 Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement .. 127 Review of Available Guidelines from Other Organizations .. 129 Quality Measurement Considerations .. 129 Statement 8: Clozapine in Suicide Risk .. 129 Implementation .. 130 Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement .. 130 Review of Available Guidelines from Other Organizations .. 131 5 Quality Measurement Considerations.

9 131 Statement 9: Clozapine in Aggressive 132 Implementation .. 132 Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement .. 132 Review of Available Guidelines from Other Organizations .. 133 Quality Measurement Considerations .. 134 Statement 10: Long-acting Injectable Antipsychotic Medications .. 134 Implementation .. 134 Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement .. 136 Review of Available Guidelines from Other Organizations .. 137 Quality Measurement Considerations.

10 138 Statement 11: Anticholinergic Medications for Acute Dystonia .. 138 Implementation .. 138 Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement .. 139 Review of Available Guidelines from Other Organizations .. 140 Quality Measurement Considerations .. 140 Statement 12: Treatments for Parkinsonism .. 141 Implementation .. 141 Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement .. 146 Review of Available Guidelines from Other Organizations .. 147 Quality Measurement Considerations.