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Methodology
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Methodology
The Team
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Adult Schizophrenia Spectrum
Adult Schizophrenia Spectrum
Diagnosis
Medication
Recommendation
Rule out alternative etiology (e.g., substance abuse, medication effects, delirium)
Actively psychotic?
Yes
No
X
Yes
No
Follow up closely
and titrate dose as
appropriate
No response at
max dose for
2-4 weeks
No
response
Adequate trial at 4-6 weeks on
optimized dose of medication
Yes
No
No
Insomnia
Decreased
appetite
Either
Yes
Agitation or
ongoing
psychosis
Schizophrenia Spectrum
and Other Psychotic Disorders
Rule out alternate etiology
(e.g., substance abuse,
medication effects, delirium)
SOR C
Actively Psychotic?
Prior Successful
Treatment?
Antipsychotic Treatment
(Preferably with atypical antipsychotics)
SOR A
Risperidone
Higher risk of EPS
(especially >4mg)
Olanzapine
Higher metabolic risk;
sedating
Aripiprazole
Lower metabolic risk;
nonsedating
Other antipsychotics
may be reasonable in
special circumstances
Quetiapine
Higher metabolic risk;
potential longer titration
to therapeutic effect
Assess
Response
No Response
Titrate toward max dose
Cross taper to another
antipsychotic and
titrate to max dose
Psychiatry Referral
Adequate Response
Use previous
successful treatment
SOR C
Intrusive symptoms
or
decreased function
Consider frequent monitoring
and follow up
Partial Response
Titrate toward max dose
Intolerable
Side effects
Partial
Response
Adjunctive
treatment
SOR C
See insomnia
decision support
Mirtazapine
Cautious
introduction of
additional
antipsychotic
Typical
Antipsychotic:
Trifluoperazine
Perphenazine
Atypical
Antipsychotic
Pretreatment
Assessment:
1. ECG
2. BMI
3. Labs (CBC, fasting
glucose, lipids, CMP)
Maintenance/
Relapse Prevention;
continue treatment that
produced adequate response
Long acting injectable
formulations may be appropriate
SOR A
Monitor for metabolic
side effects
and tardive dyskinesia
