Treatments for specific symptoms and populations

This category includes treatments for specific symptoms and specific populations, including treatments for aggressive symptoms, for people with schizophrenia and co-occurring substance abuse problems, and treatments for children and pregnant women with schizophrenia.

For high-risk groups

What are high-risk groups? A key target of early intervention is “indicated prevention” for individuals at high risk of psychosis who have been identified with early signs of the disorder, but do not meet any diagnostic criteria. There are two key approaches for identifying people with early signs. The first approach is based on Huber’s Basic Symptoms, which focuses on a detailed way of describing phenomenological (subjective) disturbances in the domains of perception, cognition, language, motor function, will, initiative and level of energy, and stress tolerance. Because the basic symptoms refer only to subtle subjectively experienced abnormalities, they may reflect…

Treatments during pregnancy and breastfeeding

What are the issues regarding antipsychotic treatment during pregnancy and motherhood?  Antipsychotic use during pregnancy requires careful consideration of the mother’s risk of illness relapse, against the risk of harm or complications for the developing infant if medication is to be continued. What is the evidence for the use of antipsychotics during pregnancy and breastfeeding? Moderate quality evidence suggests a small increased risk of heart defect or lower birth weight in infants, and a small increased risk of preterm delivery, but not stillbirth, with exposure to antipsychotics (first or second generation). Lower quality evidence is unsure about the risk of…

Treatments for aggression and agitation

How is aggression and agitation relevant to schizophrenia? Agitation and/or aggression are sometimes observed during a psychiatric emergency such as in onset of acute psychosis. Agitation typically includes irritability and restlessness, motor or verbal hyperactivity, uncooperativeness, and occasionally aggressive gestures or behaviour. This can pose a risk both to the individual, as well as the attending health care professionals, and so is important to manage this behaviour and prevent potential harm. What is the evidence for treatments for aggression and agitation? Moderate quality evidence found a small to medium-sized effect of less hostility with second-generation antipsychotics compared to first-generation antipsychotics,…

Treatments for childhood and early-onset schizophrenia

What is childhood and early-onset schizophrenia? Childhood-onset schizophrenia is defined as schizophrenia with onset prior to the age of 13 years, and early-onset schizophrenia describes schizophrenia onset between the ages of 13 and 17 years. What is the evidence for pharmaceutical treatments for childhood and early-onset schizophrenia? Compared to first-generation antipsychotics, moderate quality evidence finds a small to medium-sized benefit of second-generation antipsychotics for global and mental state in children and adolescents with schizophrenia. There was greater improvement with standard dose than low-dose antipsychotics, although there are more side effects with standard doses. Moderate quality evidence finds clozapine was the…

Treatments for cognitive symptoms

What are cognitive symptoms? Cognitive symptoms of schizophrenia have been found in all cognitive domains, including executive function, memory, and attention, and often develop prior to the other symptoms of schizophrenia. They are highly disabling and predict poor functional outcomes. What is the evidence for treatments for cognitive symptoms? Overall, moderate to high quality evidence suggests second-generation antipsychotics are associated with small improvements in processing speed, verbal fluency, learning, motor skills, long-term memory, and global cognition when compared to first generation antipsychotics, but have no benefit over first generation antipsychotics for improving attention, cognitive flexibility, working memory, delayed recall, or…

Treatments for dual diagnosis

What is dual diagnosis? Dual diagnosis is the term used for people with both mental health and substance use disorders. Studies targeting this population often investigate outcomes relating to both diagnoses, such as symptoms, substance use, social function, quality of life, and cognitive outcomes. What is the evidence for treatments for dual diagnosis? Moderate to low quality evidence suggests olanzapine was superior to perphenazine, quetiapine, risperidone, and ziprasidone for overall symptoms in people with a dual diagnosis. Olanzapine was superior to perphenazine, quetiapine, and ziprasidone for positive symptoms, and olanzapine was superior to perphenazine, risperidone, and ziprasidone for negative symptoms….

Treatments for elderly people and people with late-onset schizophrenia

What is late-onset schizophrenia? Studies of the life course of schizophrenia suggest that positive symptoms tend to reduce with time, while negative symptoms, such as social withdrawal and emotional apathy, increase with time. In contrast, people with late-onset schizophrenia (onset after 40 years of age) and very late-onset schizophrenia (onset after 60 years of age) tend to have predominant positive symptoms and fewer negative symptoms. This summary table includes both elderly people with chronic schizophrenia, and people who have been diagnosed with late-onset or very late-onset schizophrenia. What is the evidence for treatments for older people with  schizophrenia? Moderate to…

Treatments for first-episode psychosis

What are the treatments for first-episode psychosis? People with a first episode of psychosis experience distressing symptoms such as unusual beliefs or abnormal behaviour (positive symptoms) and/or withdrawal or loss of interest in work or school (negative symptoms). Early intervention programs for schizophrenia and psychosis often combine many elements comprising both pharmaceutical and psychosocial therapies, and may involve enriched therapies that are tailored to an individual’s needs. The conclusions presented here are based on group data, and as such individual treatment programs need to be tailored by trained clinicians. Individual response to treatment can vary in terms of both symptoms…

Treatments for high-risk groups

What are high-risk groups? The primary aims of early intervention are to prevent or delay future transition to psychosis in high-risk individuals with early symptoms, and to reduce symptom severity in individuals following a first episode of psychosis. A key target of early intervention is “indicated prevention”, for individuals at high risk of psychosis who have been identified with detectable signs of possible disorder, but do not meet any diagnostic criteria for disorder. There are two key approaches for identifying patients with early signs that may suggest an ultra-high risk (UHR) of developing psychosis. The first approach is based on…

Treatments for medication non-adherence

What is the importance of medication adherence? One-quarter to one-half of people with schizophrenia do not adhere to their medication. Non-adherence to maintenance treatments, including antipsychotics, is a widespread issue that plagues clinical management for schizophrenia. It reduces the success of the treatment regimen and the ability to achieve remission from illness, but it also increases the burden for psychotic relapse treatments, emergency admissions and hospitalisation. Greater adherence to treatment can contribute not only to more successful disease management and better quality of life, but also to improved attitudes towards treatment and medication, as well as increasing insight and confidence. In…

Treatments for medication-resistant schizophrenia

What is medication resistance?  Antipsychotic medications provide symptom respite and improvement in quality of life for many people with schizophrenia. However, for a subset of people with schizophrenia, antipsychotic medications do not provide adequate relief from symptoms. Treatment-resistant schizophrenia has many definitions that vary depending on the individual study, but a broad definition includes those patients whose symptoms have not responded to antipsychotic medications, or only partially responded. What is the evidence for medication resistance? Moderate to high quality evidence finds a general pattern of superiority of clozapine, olanzapine or risperidone over other antipsychotics for improving symptoms in people with…

Treatments for negative symptoms

What are negative symptoms?  Negative symptoms are referring to an absence of normal functions. This may include (but is not limited to) blunted affect, which is a scarcity of facial expressions of emotion, reduced frequency and range of gestures and voice modulation, and restricted eye contact; alogia (poverty of speech); asociality (reduced social interaction); avolition (reduced motivation and often poor hygiene) and anhedonia, which is reduced experience of pleasure. What is the evidence on treatments for negative symptoms? Moderate quality evidence finds some benefit for improving negative symptoms from second-generation, but not first-generation antipsychotics compared to placebo. Moderate to low…

Treatments for relapse prevention

What is relapse prevention? Studies have shown that about 80% of patients relapse to psychosis within 5 years of initial diagnosis. Antipsychotic drugs have played a central role in the treatment of schizophrenia for more than 50 years and antipsychotic use significantly reduces the risk of relapse. What is the evidence for relapse prevention? High quality evidence shows a small benefit of specialist first-episode psychosis programs (involving both psychosocial and pharmaceutical treatments) for reducing the risk of relapse and less all-cause discontinuation of treatment compared to treatment as usual. These programs may also reduce the length of hospital stay should…

Treatments for schizoaffective disorder

We have not found any systematic reviews specifically targeting treatments for schizoaffective disorder, as most studies on schizophrenia also include people with schizoaffective disorder. Please see the schizoaffective disorder diagnosis topic for related information. Pending enough primary studies, we invite reviews on this topic to be conducted. Alternatively, we will endeavour to conduct our own review to fill this gap in the Library. March 2019

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Title Colour Legend:
Green - Topic summary is available.
Orange - Topic summary is being compiled.
Red - Topic summary has no current systematic review available.