Schizophrenia treatment based on practice guidelines

The practice guideline on schizophrenia by the German Society of Psychiatry, Psychotherapy and Nervous Diseases (DGPPN) includes systematically developed and evidence-based treatment recommendations that assist clinicians and patients in making decisions about appropriate treatment for specific conditions. The practice guideline intends to improve the quality of care and outcome of schizophrenia This paper reviews the process of the guideline development and discusses selected aspects of acute and long-term treatment as well as treatment strategies under special conditions with regard to recent published studies. The recommendation of preferential using second generation antipsychotics is based upon hints towards superior efficacy in the improvement of negative symptoms, cognitive dysfunction, relapse prevention and a lower risk of tardive dyskinesia. These advantages have to be balanced against the higher risk of weight gain, elevation of blood glucose and other metabolic side effects of some second generation antipsychotics. Within the selection of the specific antipsychotic agent individual treatment conditions, previous treatment response, and substance-related side effects on metabolism, circulation and blood pressure, blood cell count and hormonal status should be considered. Besides pharmacotherapy, psychological and sociotherapeutic interventions should be included routinely in the treatment plan depending on the individual treatment phase.