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Treatment
Î Psychosocial treatments in the stable phase
• Select appropriate psychosocial treatments based on the patient's needs
▶ Family interventions
▶ Supported employment
▶ Assertive community treatment (ACT)
▶ Social skills training
▶ Cognitive behavior therapy (CBT)
▶ Weight management
▶ Cognitive remediation
▶ Peer support and peer delivered services
▶ Combined psychosocial interventions
Î Antipsychotics in the stable phase
• Administer conventional antipsychotics at a dose close to the EPS threshold
• Atypical antipsychotics can usually be administered at doses that are therapeutic
without inducing EPS
• Weigh advantages of decreasing antipsychotic dose against risk of relapse
• Evaluate negative symptoms
▶ Secondary to Parkinsonian syndrome?
▶ Anticholinergics or other sedating agents?
▶ Untreated major depression?
Î Adjunctive medications in the stable phase
• Add psychotropic medications in order to:
▶ Treat comorbid conditions
▶ Treat aggression
▶ Treat anxiety and other mood symptoms
▶ Augment antipsychotic effects of the primary medication
▶ Treat side effects
• Weight management
▶ Metformin
▶ Topiramate
Î Use of ECT in the stable phase
• Maintenance ECT may be useful
▶ Patients who responded to acute ECT treatment
▶ Pharmacologic prophylaxis ineffective or intolerable
Î Encourage patient to use self-help treatment organizations
