Principles of practice from the European expert panel on the contemporary treatment of schizophrenia

Providing optimal treatment for people with schizophrenia is a difficult long-term problem for clinicians and healthcare providers. Over the years a variety of approaches to treatment have evolved and, until now, there have been no widely accepted standards for care. To determine the principles underpinning the best practice for schizophrenia treatment, an Expert Panel of European psychiatrists and psychologists has worked to distil current theory, collective practical experiences and published literature into 17 basic Principles of Practice . These are not intended to duplicate or replace local treatment policies or guidelines. Instead, they describe best practice in diagnosis, patient assessment and long-term treatment of schizophrenia as it exists at the beginning of the 21st century and is likely to exist in the near future. The Principles of Practice broadly fall into four main categories: (1) assessment, diagnosis and care provision; (2) treatment in day-to-day practice; (3) building a positive therapeutic alliance; and (4) a long-term clinical commitment. Running through all the Principles are several common threads - the fundamental importance of the therapeutic alliance between the clinician and the patient, the need to plan both for treatment efficacy and avoidance of side-effects and the importance of long-term treatment planning. It is intended that psychiatrists and other healthcare professionals can use the Principles as a benchmark for optimum patient management, and as a tool when negotiating the future of local and national schizophrenia management services. Furthermore, the Principles of Practice represent a first step in the development of a new patient-centred philosophy for the care of people with schizophrenia.

From first episode to long-term care: The need for sustained clinical commitment

There is considerable evidence to suggest that many patients experience difficulties in gaining access to treatment after the onset of significant symptoms and social disability. Delay in obtaining appropriate support and treatment can have profound effects on both the patient and their family and may also be associated with a poorer long-term outcome. As stated in the Principles of Practice, prompt and comprehensive clinical assessment, by a clinician experienced in the recognition and treatment of severe mental illness, is therefore important for achieving the best possible outcome for the patient. The primary objectives of early-stage treatment for schizophrenia are to achieve a full improvement in psychopathological symptoms and a recovery of premorbid levels of function. However, even with optimal treatment, the reality for many patients is that their symptoms and impairment continue. Many patients can therefore be regarded as only partially responsive, or even resistant, to treatment. When assessing the utility of an antipsychotic treatment regimen for such patients, clinicians should not just consider the objective manifestations of the disorder but also the subjective experience of the patient. Relapse of illness is also a common and serious problem for many patients with schizophrenia, despite continual treatment. Prevention and management of relapse are two of the main challenges in the effective treatment of schizophrenia. The optimal use of antipsychotic treatment and the adherence by patients to that treatment offer valuable protection against relapse. Symptoms of depression or low mood affect a high proportion of patients with schizophrenia at some point in their illness and are also associated with an increased risk of relapse. Treatment objectives in the early stages may need to be modified if a pattern of partial response or resistance to treatment, a cycle of relapse of the illness or the presence of depressive symptoms, develops. Clinicians should continue to offer a sustained and positive clinical commitment to all.