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National Guidelines for Antipsychotic Drug Therapy for Schizophrenia or Schizophrenia-type Conditions – summary

These guidelines provide recommendations regarding antipsychotic drug treatment for schizophrenia or schizophrenia-type conditions.

The recommendations are based primarily on a systematic literature review on the subject of drug therapy for schizophrenia prepared by the Swedish Council on Health Technology Assessment (SBU).

Schizophrenia is a severe psychotic disorder that entails an altered perception of reality, impaired social and cognitive abilities, which in turn often causes functional impairment. In these guidelines, the National Board of Health and Welfare provides recommendations for various types of antipsychotic drug therapies regarding

  • the prodromal phase
  • first-episode psychosis
  • chronic psychosis
  • treatment-refractory psychosis
  • suicidal behaviour in patients with psychosis
  • weight gain in connection with antipsychotic drug treatment
  • extrapyramidal side effects of antipsychotic drug treatment
  • treatment with antipsychotic drugs with depot injections
  • comorbidity with addiction or dependence of alcohol or narcotics.

A few important recommendations

Healthcare providers should offer continuous antipsychotic drug treatment to persons with schizophrenia or schizophrenia-type conditions. Continuous antipsychotic drug treatment reduces the risk of suicide and is also a prerequisite to avoid acute episodes, and to rehabilitate and reintegrate persons with schizophrenia or schizophrenia-type conditions into society. Without antipsychotic drug treatment, it is generally impossible for those afflicted to lead a normal life.

It is important that the choice of antipsychotic drug is based on the severity of the illness, and on what possible risks are connected to the patient's condition, e.g., suicidal behaviour or metabolic risk factors. Different antipsychotic drugs have different effects and side effects. Common side effects of antipsychotic drug include sexual side effects, extrapyramidal symptoms, sedation (fatigue) and weight gain. These occur in particular when introducing a new drug. If the patient is well-informed of the effects and side effects of various drugs, and actively participates in the choice of drug in accordance with shared decision making, the adherence to the treatment will increase.

Healthcare providers should offer Aripiprazole, Olanzapine or Risperidone to patients experiencing their first-episode psychosis. Patients with chronic schizophrenia should be offered Olanzapine or Risperidone. In cases of long-term illness, it is particularly important that drug treatment is continuous and sustained.

In cases of treatment-resistant illness and insufficiently effective antipsychotic drugs (meaning that symptoms remain despite adequate doses and treatment period), it is important to switch to a drug more effective on psychotic symptoms. Healthcare providers should then primarily offer Clozapine. It is also of particular importance that the drug treatment is combined with psychosocial interventions.

Patients with suicidal ideations and behaviours should also be offered Clozapine, both when experiencing a first-episode psychosis or chronic psychosis. The reason for this is that Clozapine reduces the risk of suicide and suicide attempts to a higher degree than any other antipsychotic drug. Some patients prefer receiving drug treatment in the form of long-acting depot injections over oral preparations. This form of treatment should also be offered to patients who repeatedly interrupt treatment and relapse into acute symptoms. If there is concomitant abuse or addiction, the healthcare provider should offer depot injections of Risperidone.

For persons who are receiving drug treatment but still display residual symptoms or functional impairment, it is important to supplement treatment with individually tailored psychosocial interventions. These guidelines supplement the National Board of Health and Welfare's National Guidelines for Psychosocial Interventions for Schizophrenia or Schizophrenia-type Conditions 2011.