Clinical Review Fortnightly review

Treatment of schizophrenia

BMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7216.1045 (Published 16 October 1999) Cite this as: BMJ 1999;319:1045
  1. John McGrath, director (jjm@brain.wph.uq.edu.au)a,
  2. W Brett Emmerson, directorb
  1. a Queensland Centre for Schizophrenia Research, Wolston Park Hospital, Wacol, Q4076 Australia
  2. b Division of Mental Health Services, Royal Brisbane Hospital and District Heath Service, Herston, Q4029 Australia
  1. Correspondence to: J McGrath

    This selective review on the treatment of schizophrenia provides an update on two important issues. Firstly, new antipsychotic drugs have improved the quality of life for people with schizophrenia. This review outlines some practical issues surrounding the use of these drugs Secondly, evidence suggests that the prompt identification and treatment of people with psychoses (including schizophrenia and affective psychoses) results in improved clinical outcomes.1 The important role that general practitioners can play in reducing the duration of untreated psychosis is also discussed.

    Summary points

    Drug treatment is effective in managing acute psychosis and in reducing the risk of relapse

    Newer antipsychotics, apart from clozapine, seem to be as effective in treating positive symptoms as traditional antipsychotics but have fewer, less severe side effects

    Clozapine is more effective than traditional antipsychotics and should be offered to patients who have not responded to other antipsychotic drugs

    Health services and community agencies need to collaborate to reduce the amount of time that patients with psychosis remain untreated

    General practitioners are playing increasingly prominent roles in new models of delivering services to people with schizophrenia

    Methods

    In writing this review, we collated the advice given in clinical practice guidelines for the management of schizophrenia that had been published in the past three years.26 Relevant reviews in the Cochrane Library were inspected.

    What is schizophrenia?

    The schizophrenic disorders are a group of illnesses characterised by various combinations of neuropsychiatric symptoms. Modern diagnostic classifications also include criteria related to the duration of symptoms, declines in functioning, and an absence of comorbid neurological disease. Problems with attention and memory may be prominent in psychoses, for example some patients have difficulties with novel tasks that require flexibility and planning. The so called positive symptoms of schizophrenia include hallucinations, delusions, and disorganised communication. The so called negative symptoms of schizophrenia include …

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