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- 1 St Vincent's Hospital, Melbourne, VIC
- 2 University of Melbourne, Melbourne, VIC
- 3 University of Adelaide, Adelaide, SA
- 4 Northern Mental Health, Adelaide, SA
- 5 Metro South Health, Brisbane, QLD
- 6 University of Queensland, Brisbane, QLD
- 7 Northland District Health Board, Whangarei, New Zealand
- 8 University of Auckland, Auckland, New Zealand
- 9 University of Western Australia, Perth, WA
- 10 Orygen Youth Health, Melbourne, VIC
- 11 Alfred Health, Melbourne, VIC
- 12 Monash University, Melbourne, VIC
- 13 National Centre of Excellence in Youth Mental Health, Melbourne, VIC
- 14 headspace National Youth Mental Health Foundation, Melbourne, VIC
- 15 Macquarie University, Sydney, NSW
- 16 Medical Research Foundation, Royal Perth Hospital, Perth, WA
- 17 Centre for Clinical Research in Neuropsychiatry, University of Western Australia, Perth, WA
Correspondence: david.castle@svha.org.au
Acknowledgements:
We thank Susie Hincks, Lived Experience Advisor for her contribution to the guidelines.
Competing interests:
No relevant disclosures.
- 1. Castle DJ, Buckley P. Schizophrenia, 2nd ed. Oxford: Oxford University Press, 2015.
- 2. Morgan VA, McGrath JJ, Jablensky A, et al. Psychosis prevalence and physical, metabolic and cognitive co-morbidity: data from the second Australian national survey of psychosis. Psychol Med 2014; 44: 2163-2176.
- 3. Morgan VA, Waterreus A, Jablensky A, et al. People living with psychotic illness 2010: report on the Second Australian national survey. Canberra: Commonwealth of Australia; 2011. http://www.health.gov.au/internet/main/publishing.nsf/content/717137a2f9b9fcc2ca257bf0001c118f/$file/psych10.pdf (accessed May 2017).
- 4. Galletly C, Castle D, Dark F, et al. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders. Aust NZ J Psychiatry 2016; 50: 410-472.
- 5. McGorry P, Killackey E, Lambert T, et al. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of schizophrenia and related disorders. Aust NZ J Psychiatry 2005; 39: 1-30.
- 6. Galletly CA, Foley DL, Waterreus A, et al. Cardiometabolic risk factors in people with psychotic disorders: the second Australian national survey of psychosis. Aust NZ J Psychiatry 2012; 46: 753-761.
- 7. National Health and Medical Research Council. NHMRC additional levels of evidence and grades for recommendations for developers of guidelines. 2009. Canberra: NHMRC; 2009. https://www.nhmrc.gov.au/_files_nhmrc/file/guidelines/developers/nhmrc_levels_grades_evidence_120423.pdf (accessed Nov 2016).
- 8. Morgan VA, Waterreus A, Jablensky A, et al. People living with psychotic illness in 2010: the second Australian national survey of psychosis. Aust NZ J Psychiatry 2012; 46: 735-752.
- 9. Stafford MR, Jackson H, Mayo-Wilson E, et al. Early interventions to prevent psychosis: systematic review and meta-analysis. BMJ 2013; 346: f185.
- 10. Lubman DI, King JA, Castle DJ. Treating comorbid substance use disorders in schizophrenia. Int Rev Psychiatry 2010; 22: 191-201.
- 11. Cooper J, Mancuso SG, Borland R, et al. Tobacco smoking among people living with a psychotic illness: the second Australian Survey of Psychosis. Aust NZ J Psychiatry 2012; 46: 851-863.
- 12. Liu D, Myles H, Foley DL, et al. Risk factors for obstructive sleep apnea are prevalent in people with psychosis and correlate with impaired social functioning and poor physical health. Front Psychiatry 2016; 7.
- 13. Moore S, Shiers D, Daly B, et al. Promoting physical health for people with schizophrenia by reducing disparities in medical and dental care. Acta Psychiatr Scand 2015; 132: 109-121.
- 14. Buckley PF, Miller BJ, Lehrer DS, Castle DJ. Psychiatric comorbidities and schizophrenia. Schizophr Bull 2009; 35: 383-402.
- 15. Shah S, Mackinnon A, Galletly C, et al. Prevalence and impact of childhood abuse in people with a psychotic illness. Data from the second Australian national survey of psychosis. Schizophr Res 2014; 159: 20-26.
- 16. Morgan VA, Morgan F, Galletly C, et al. Sociodemographic, clinical and childhood correlates of adult violent victimisation in a large, national survey sample of people with psychotic disorders. Soc Psychiatry Psychiatr Epidemiol 2016; 51: 269-279
- 17. Morgan VA, Castle DJ, Jablensky AV. Do women express and experience psychosis differently from men? Epidemiological evidence from the Australian National Study of Low Prevalence (Psychotic) Disorders. Aust NZ J Psychiatry 2008; 42: 74-82.
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Abstract
Introduction: The Royal Australian and New Zealand College of Psychiatrists (RANZCP) clinical practice guidelines for the management of schizophrenia and related disorders provide evidence-based recommendations for optimising treatment and prognosis. This update to the 2005 RANZCP guidelines has a greater emphasis on psychosocial treatments, physical health comorbidities and vocational rehabilitation.
Main recommendations: The guidelines advise a clinical staging approach and deliver specific recommendations for:•comprehensive treatment using second generation antipsychotic agents continuously for 2–5 years;•early treatment of comorbid substance use;•community treatment after initial contact, during crises and after discharge from hospital;•physical health monitoring and management of comorbidities, particularly metabolic health;•interventions to optimise recovery of social function and return to study or work; and•management of schizophrenia in specific populations and circumstances.
Changes in management as a result of the guidelines: The guidelines provide benchmarks against which the performance of services and clinical teams can be assessed. Measuring treatment response and clinical outcome is essential. General practitioners have an important role, particularly in monitoring and reducing the high cardiovascular risk in this population. Clinical services focusing on early detection, treatment and recovery need continuous funding to be proactive in implementing the guidelines and closing the gap between what is possible and what actually occurs.