Pharmacological and related approaches
Initial treatment in first episode psychosis
D Following initiation of an antipsychotic medication for service users
in the first episode of psychosis, the medication should be continued
for at least two weeks unless there are significant tolerability issues.
Assessment of dose and response should be monitored during the
early phase of prescribing.

D Where there is poor response to medication there should be an
assessment of medication adherence and inter-current substance
misuse before the lack of response can be definitively established.

D If there is no response to medication after four weeks, despite dose
optimisation, a change in antipsychotic should be considered.

D Where there is partial response, this should be re-assessed after eight
weeks unless there are significant adverse effects.

D Minimum effective dose of either first- or second-generation
antipsychotics should be used in individuals in the first episode of
schizophrenia.

D Following remission of the first episode of schizophrenia, the duration
of maintenance treatment with antipsychotics should be at least 18
months.

Treating acute exacerbation or recurrence

A In service users with an acute exacerbation or recurrence of
schizophrenia prescribers should consider amisulpride, olanzapine
or risperidone as the preferred medications with chlorpromazine and
other low-potency first-generation antipsychotics providing suitable
alternatives. Consideration should be given to previous response
to individual antipsychotic medications and relative adverse effect
profiles.

D Following initiation of an antipsychotic medication for acute
exacerbation of schizophrenia, the medication should be continued
for at least four weeks unless there are significant tolerability issues.

D Where a partial response is seen after review at four weeks, the
medication should be re-assessed after eight weeks unless there are
significant adverse effects.

Treatment to prevent relapse during remission
A Individuals with schizophrenia which is in remission should be offered
maintenance treatment with an antipsychotic medication.

B For maintenance treatment, prescribers should consider amisulpride,
olanzapine or risperidone as the preferred medications with
chlorpromazine and other low-potency first-generation antipsychotics
providing suitable alternatives.

A Individuals with schizophrenia which is in remission should be offered
maintenance treatment with antipsychotic medication for a minimum
of two years.

B Individuals with schizophrenia who request depot and those with
medication adherence difficulties should be offered maintenance
treatment with depot antipsychotic medication.

Clozapine should be offered to service users who have treatmentresistant schizophrenia.

B Clozapine should be considered for service users whose schizophrenia
has not responded to two antipsychotics including a secondgeneration antipsychotic medication.

C A trial of clozapine augmentation with a second SGA should be
considered for service users whose symptoms have not responded
adequately to clozapine alone, despite dose optimisation. Treatment
should be continued for a minimum of ten weeks.

B A trial of clozapine augmentation with lamotrigine may be considered
for those service users whose symptoms have had an insufficient
response to clozapine alone.

The decision to switch antipsychotic medication should take into
account the risk of destabilisation and adverse effects and the dose of
medications should be gradually cross tapered.

D Prescribing high dose antipsychotics should only be considered after
adequate trials of antipsychotic monotherapy and augmentation,
including a trial of clozapine, has failed.

EVIDENCE BASED GUIDELINES- UK- MARCH 2103.

G.MOHAN