Introduction

Introduction

The NICE clinical guideline on psychosis and schizophrenia in adults describes schizophrenia as a major psychiatric disorder, or cluster of disorders, characterised by psychotic symptoms that alter a person's perception, thoughts, mood and behaviour. Each person with the disorder will have a unique combination of symptoms and experiences. NICE states that, over a lifetime, about 1% of the population will develop schizophrenia.

The NICE clinical guideline on psychosis and schizophrenia in adults recommends that people with a first episode of schizophrenia, or an acute exacerbation or recurrence of schizophrenia, should be offered oral antipsychotic medication in conjunction with psychological interventions. The NICE clinical guideline also recommends that depot or long-acting antipsychotics may be offered to people who would prefer such treatment after an acute episode of schizophrenia, or where avoiding covert non-adherence (either intentional or unintentional) to antipsychotic medication is a clinical priority within the treatment plan. When initiating depot or long-acting antipsychotics, the service user's preferences and attitudes towards regular intramuscular injections and organisational procedures (for example, home visits or location of clinics) should be taken into account.

The NICE clinical guideline recommends that the choice of antipsychotic medication should be made by the service user and healthcare professional together, taking into account the views of the carer if the service user agrees. Information should be provided on, and there should be discussion about, the likely benefits and possible side effects of each drug, including metabolic, extrapyramidal, cardiovascular, hormonal and other side effects (including unpleasant subjective experiences). The BNF chapter on antipsychotic drugs describes the relative efficacy and adverse effects of different antipsychotics. A National Prescribing Centre patient decision aid provides a guide to the relative adverse effects of different antipsychotics, based on information available at that time (2009).