Psychiatry

Introduction This article summarises the recently published ‘Australian and New Zealand Journal of Psychiatry (ANZJP) Grading of Recommendations, Assessment, Development and Evaluations (GRADE) Guidelines for the Management of Schizophrenia in Australia and Aotearoa New Zealand’ (https://journals.sagepub.com/doi/10.1177/00048674251406058).MethodsWe used the GRADE approach to evaluate the certainty of existing evidence and the strength of the recommendation was determined by the panel. The Guidelines are organised into seven sections: (1) physical health assessment; (2) pharmacological treatment; (3) psychological and psychosocial interventions; (4) family, whānau and carer involvement; (5) psychiatric comorbidities; (6) physical health and lifestyle interventions; and (7) special populations.Main RecommendationsA comprehensive yet tailored clinical assessment should be undertaken to identify treatable physical health comorbidities early, particularly for people with early psychosis.Pharmacotherapy should aim for the lowest effective dose with a tolerable and manageable adverse-effect profile (e.g., first-line pharmacotherapy with aripiprazole, brexpiprazole, cariprazine or lurasidone).Lifestyle interventions, particularly physical activity and multimodal lifestyle programmes, should be routinely offered to people with schizophrenia.Psychological and psychosocial interventions are essential components of care for people with schizophrenia, especially during the maintenance phase of illness.Clinicians should actively involve people with schizophrenia and their family, whānau and carers in shared decision-making.Comorbid psychiatric symptoms and conditions should be assessed and managed according to standard treatment approaches until more robust evidence base specific to schizophrenia becomes available.Changes in Assessment and Management as a Result of the GuidelinesThe ANZJP GRADE Guidelines synthesise the current evidence base across key domains relevant to the management of people with schizophrenia, offering practical recommendations that can be implemented in both clinical and systemic contexts. General practitioners have a pivotal role, especially in supporting the physical health and overall wellbeing of people with schizophrenia and assisting them to navigate complex healthcare pathways.

Shuichi Suetani, Frances Dark, Susanna Every-Palmer, Cherrie Galletly, Brian O'Donoghue, Sean Halstead, Dolores Keating, Steve Kisely, Nicole Korman, Julia Lappin, Sharon Lawn, Andrew Thompson, Nicola Warren, Dan J. Siskind