• Goals of treatment

    • Ensure that symptom remission or control is sustained.

    • Maintain or improve the patient's level of functioning and quality of life.

    • Effectively treat increases in symptoms or relapses.

    • Continue to monitor for adverse treatment effects.


1. Assessment in the Stable Phase

  • Ongoing monitoring and assessment are necessary to determine whether the patient might benefit from alterations in the treatment program.

  • Perform a clinical assessment for extrapyramidal symptoms (for patients taking antipsychotic medications) at each clinical visit.

  • Perform a clinical assessment for abnormal involuntary movements every 6 months for patients taking first-generation antipsychotics and every 12 months for patients taking second-generation antipsychotics. For patients at increased risk (e.g., elderly patients), assessments should be made every 3 months and 6 months with treatment using first-generation and second-generation antipsychotics, respectively.

  • Monitor the patient's weight and BMI at each visit for 6 months and quarterly thereafter. For patients with BMI in the overweight (25 to 29.9 kg/m2) or obese (30 kg/m2) range, routinely monitor for obesity-related health problems (e.g., blood pressure, serum lipids, clinical symptoms of diabetes).

  • Monitor fasting blood glucose or hemoglobin A1c at 4 months and then annually, and monitor other blood chemistries (e.g., electrolytes; renal, liver, and thyroid function) annually or as clinically indicated; consider drug toxicology screen if clinically indicated.

  • Depending on the specific medication being prescribed, consider other assessments, including vital signs, CBC, ECG, screening for symptoms of hyperprolactinemia, and ocular examination.

  • If the patient agrees, maintain strong ties with individuals who are likely to notice any resurgence of symptoms and the occurrence of life stresses and events.


2. Psychosocial Treatments in the Stable Phase

  • Select appropriate psychosocial treatments based on the circumstances of the individual patient's needs and social context.

  • Psychosocial treatments with demonstrated efficacy include

    • family interventions,

    • supported employment,

    • assertive community treatment,

    • social skills training, and

    • cognitive behaviorally oriented psychotherapy.


3. Use of Antipsychotic Medications in the Stable Phase

  • Antipsychotics can reduce the risk of relapse in the stable phase of illness to less than 30% per year.

  • For most patients treated with first-generation antipsychotics, clinicians should prescribe a dose close to the "EPS threshold" (i.e., the dose that will induce extrapyramidal side effects with minimal rigidity detectable on physical examination).

  • Second-generation antipsychotics can generally be administered at doses that are therapeutic but that will not induce extrapyramidal side effects.

  • Weigh advantages of decreasing antipsychotics to the "minimal effective dose" against a somewhat greater risk of relapse and more frequent exacerbations of schizophrenia symptoms.

  • Evaluate whether residual negative symptoms are in fact secondary to a parkinsonian syndrome or an untreated major depressive syndrome, and treat accordingly.


4. Use of Adjunctive Medications in the Stable Phase

  • Add other psychoactive medication to antipsychotic medications in the stable phase to treat comorbid conditions, aggression, anxiety, or other mood symptoms; to augment the antipsychotic effects of the primary drug; and to treat side effects.


5. Use of ECT in the Stable Phase

  • Maintenance ECT may be helpful for some patients who have responded to acute treatment with ECT but for whom pharmacologic prophylaxis alone has been ineffective or cannot be tolerated.


6. Encourage the Patient and Family to Use Self-Help Treatment Organizations


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