New Schizophrenia Guidelines

Automatic TRANSCRIPT

Lot has changed since 2004 when the APA the last road practice guidelines on schizophrenia this September and twenty-twenty. They updated those guidelines and here's a few of the key changes. There's less emphasis on divorce pushing between the conventional or first generation antipsychotics and the second generation or a typical perhaps because the Katy Trail put an end to the notion that the newer ones are better tolerate or the older ones are more effective, but the guidelines do Place greater emphasis on clozapine. They recommend clozapine after a patient has failed to respond to two trials of a guy psychotics and they Define failure of response meaning less than a 20% response and unlike the 2004 guidelines. They don't require that one of those trucks. Else be with the first-generation antipsychotic. They also recommend clozapine first line for a number of patients, which when you think of it is a lot of people with schizophrenia, those are people with suicidality problematic aggression and potentially with tardive dyskinesia. That doesn't respond to other options. The guidelines do go into great detail on how to treat side effects to antipsychotics. They list metformin as first-line for weight gain and metabolic syndrome and they list the vmat2 Inhibitors two of which are like ft approved and one of which are not all is first line for tardive dyskinesia. That's one area where I might differ from the guidelines they seem to emphasize these FDA-approved treatments, which actually have a fairly poor number needed to treat and not-so-great tolerability and are extremely expensive at $80,000 a year and they give real short shrift wage. Other options for tardive dyskinesia things like ginkgo biloba extract Keppra and amantadine which were actually given more emphasis in the neurology guidelines wage in several places. The guidelines give Credence to the idea of checking blood levels on antipsychotics to see if the patient is actually taking them a lot of authors of advocated for this and the fact here is that you just don't know if the patient is taking it even though the blood levels of most antipsychotics don't correlate with any therapeutic level except for clozapine where the therapeutic effects are greater above blood levels of 350. It's still useful to check them before moving to clozapine because you don't know if the patient even took the medication that you gave them too often. They don't and perhaps the biggest and most welcome change here is the emphasis on psychosocial therapies while they were recommended in a more generic form in 2004 here they recognized A whole host of specific psychosocial programs for people with schizophrenia so they can get their lives back. Here's one that was striking to me. They recommend that all first episode page be treated and something called a coordinated Specialty Care Program. These are things that have been researched since 2004 and shown to improve outcomes. They are team based programs incorporate both medications along with education resiliency training family therapy and vocational rehab sounds like a full pallet of what people need when they're going through them first episode too bad. These programs are hard to find but they're starting to Institute the more public Mental Health Centers and some academic centers have them but helpfully the guidelines do give you a reference to free resources where you can train your staff to start one locally

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