People with schizophrenia must have a say in their treatment

BMJ 2002; 325 doi: (Published 07 December 2002) Cite this as: BMJ 2002;325:1317
  1. Susan Mayor
  1. London

    People with schizophrenia in England and Wales should be involved in all decisions on their care and should be offered psychological as well as drug treatment. These are two of the recommendations in guidelines published by the National Institute for Clinical Excellence (NICE) this week.

    The guidelines outline what was judged to be best practice for health professionals caring for individuals with schizophrenia, after review of available evidence by a group of health professionals and people with schizophrenia.

    The first recommendation—“health professionals should work in partnership with service users and carers, offering help, treatment and care in an atmosphere of hope and optimism”—emphasises the need for shared decision making and informed consent in all aspects of schizophrenia care.

    The chairman of the guidelines committee, Tim Kendall, who is also joint director of the National Collaborative Centre for Mental Health and medical director of community health, Sheffield, commented: “The very collaborative process used in developing the guideline has resulted in a strong recommendation for the humanity we need to bring to the care of people with schizophrenia.”

    The guidelines recognise that the nature of schizophrenia can make it difficult for people to make informed decisions about their treatment, but they advise health professionals to make all efforts necessary to ensure that a service user can give meaningful and properly informed consent before treatment is started. The guidlines recommend that any medicine used in treatment should be chosen jointly by the person with schizophrenia and the clinician.

    The guidelines recommend greater use of psychological treatments and more appropriate use of drugs for schizophrenia. Oral atypical antipsychotic drugs, at the lower end of the standard dose range, should be considered in the choice of first line treatments for individuals with newly diagnosed schizophrenia.

    The use of moderate doses of antipsychotic medicines was recommended, with the aim of avoiding the use of high doses and loading doses that are sometimes used at the moment. People with schizophrenia should take only one antipsychotic drug at a time, except in rare cases. Dr Kendall pointed out that nearly half of people being treated with neuroleptics are currently taking more than one drug. There is no evidence that this is beneficial for most people, he warned.

    Psychological treatments—particularly cognitive behaviour therapy and family interventions—were recommended as an indispensable part of the treatment for people with schizophrenia and their families. The guidelines recommend that anyone with psychotic symptoms should be offered at least 10 sessions of cognitive behaviour therapy.

    Embedded Image

    Russell Crowe plays mathematician John Nash, who had schizophrenia, in the film A Beautiful Mind

    (Credit: KOBAL)


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