Areas for Further Research in Individuals With Schizophrenia
Overall
▫
Improve the generalizability of study populations
▫
Enhance study recruitment approaches and use a priori specification of subgroup analyses to obtain data on treatment effects in inpatients, minority groups, women, older individuals, individuals with multiple psychiatric or physical health conditions, and individuals with severe and/or treatment-resistant illness
▫
Assure that sample sizes are adequate to achieve statistical power
▫
Assure that studies report data in a consistent fashion and prespecify outcomes of interest
▫
Assure that studies identify the magnitude of change in scale scores that constitutes a clinically meaningful difference
▫
Increase collection of data on patient-centered outcomes (e.g., quality of life, social functioning, physical health, recovery)
▫
Improve systematic collection of information on harms, including in studies of psychosocial interventions
▫
Identify approaches (e.g., pharmacogenomics, biomarkers, symptom clusters, and other predictive variables) for optimizing treatment selection
▫
Determine efficient, valid, and reliable approaches to quantitative measurement of positive symptoms, negative symptoms, functioning, quality of life, and treatment-related side effects
▫
Determine ways in which demographic or sociocultural factors influence treatment outcomes
▫
Determine the durability of treatment effects and potential for long-term harms through long-term studies (e.g., at least 1 year of treatment with follow-up assessments at 3–5 years)
▫
Determine the benefits, harms, and appropriate use of treatments in individuals with co-occurring disorders (e.g., stimulants in co-occurring ADHD; benzodiazepines with co-occurring anxiety; smoking cessation interventions, including medication and nonmedication approaches with co-occurring nicotine dependence)
▫
Identify methods that will allow information from mobile technologies, wearable technology, and large-scale data analytics to inform assessment, treatment, and future research
▫
Determine optimal monitoring frequencies and approaches to detect treatment-related benefits and side effects
▫
Identify optimal approaches to improving physical health in individuals with schizophrenia
▫
Identify optimal approaches to treatment of co-occurring substance use disorders in individuals with schizophrenia
▫
Identify approaches to redesigning workflows and models of care delivery to improve the use of best practices in the treatment of schizophrenia
▫
Identify approaches to determining the optimal setting of care (e.g., inpatient, partial hospital, intensive outpatient, psychosocial rehabilitation, Clubhouse models)
▫
Identify optimal approaches to integrate recovery-based and peer-based programs into other models of care delivery
▫
Identify optimal approaches to care coordination and case management, including intensive case management
Medications and Other Somatic Interventions
▫
Determine the comparative effectiveness of newer SGAs (including LAI formulations) versus comparable doses of other SGAs and some FGAs
▫
Determine the comparative harms of antipsychotic medications, including long-term harms and rare but serious harms
▫
Determine optimal antipsychotic treatment approaches for individuals with suicidal or aggressive behaviors, including additional studies of clozapine for aggressive behavior
▫
Identify risks and benefits of using other medications (e.g., lithium, anticonvulsants, antidepressants, stimulants, benzodiazepines, other sedative-hypnotics) in combination with antipsychotic medications to address specific target symptoms or treatment nonresponse
▫
Identify risks and benefits of concomitant use of more than one antipsychotic medication
▫
Identify risks and benefits of strategies to minimize or treat side effects of antipsychotic medications, including use of concomitant medications, reductions in antipsychotic dose, or changing to a different antipsychotic medication
▫
Determine optimal approaches to making medication changes (i.e., switching from one antipsychotic to another) to minimize risk of relapse and reduce potential for treatment-related side effects
▫
Identify optimal clinical approaches for determining when a treatment trial is adequate and when treatment resistance is present
▫
Determine relationships between blood levels of antipsychotic medications (including active metabolites) and therapeutic response that can be used to guide dose titration and determination of treatment adequacy
▫
Identify whether there are subgroups of patients for whom medication discontinuation may be possible
▫
Determine whether intermittent treatment or early relapse is associated with increased long-term harms (e.g., greater treatment resistance, neurobiological changes)
▫
Determine optimal approaches to prevention and treatment of specific side effects of antipsychotic medications, including neurological side effects, weight gain, diabetes, metabolic syndrome, and cardiovascular disease
▫
Determine the optimal duration of treatments for neurological side effects (e.g., VMAT2 inhibitors for tardive dyskinesia, anticholinergic agents for parkinsonism)
▫
Determine the efficacy and comparative effectiveness of neurostimulation approaches (e.g., ECT, TMS) in conjunction with other treatments for schizophrenia
Psychosocial Interventions
▫
Assure that psychosocial interventions are clearly defined and described and that measurements of fidelity to the intervention model are incorporated into the study design
▫
Conduct research on optimizing long-term outcomes with psychosocial interventions (e.g., use of booster treatment sessions or continued treatment at a lower frequency for maintenance of therapeutic benefits in those with a good initial response)
▫
Develop approaches to reduce the heterogeneity in usual care groups, which makes it difficult to interpret and compare studies of psychosocial interventions that use usual care as a control comparison
▫
Assure that studies of psychosocial interventions determine the intensity, frequency, and duration of treatment that is needed to optimize outcomes
▫
Develop methods to study psychosocial interventions to identify key contributors to benefit (e.g., clinician experience, treatment fidelity, use of shared decision-making, clinician-patient alliance, family engagement, setting of care)
▫
Investigate the benefits and harms of other psychosocial interventions (e.g., mindfulness, acceptance and commitment therapy, metacognitive reflection and insight therapy, Open Dialogue, exercise, music and dance therapies)
▫
Determine benefits, harms, and optimal approaches for implementation of peer-based services, recovery-oriented programs, and self-management strategies
▫
Determine the components of multicomponent interventions (e.g., CSC) that are crucial to positive outcomes
▫
Determine the effectiveness and sustainability of CSC with longer-term program participation
▫
Determine the elements of supported employment programs that are most likely to foster long-term competitive employment
Information & Authors
Information
Published In
The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia
September 2020
©American Psychiatric Association Publishing
Authors
Metrics & Citations
Metrics
Citations
If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download.
For more information or tips please see 'Downloading to a citation manager' in the Help menu.
View Options
View options
Login options
Already a subscriber? Access your subscription through your login credentials or your institution for full access to this article.
Personal login Institutional Login Open Athens loginNot a subscriber?
PsychiatryOnline subscription options offer access to the DSM-5-TR® library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.
Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).