Pharmacological and Somatic Treatments for First-Episode Psychosis and Schizophrenia: Synopsis of the US Department of Veterans Affairs and US Department of Defense Clinical Practice Guidelines

IF 5.3 1区医学 Q1 PSYCHIATRY

Schizophrenia Bulletin Pub Date : 2025-06-28 DOI:10.1093/schbul/sbaf053

Robert W Buchanan, Ira Katz, Fuad Issa, Rachael Coller, Matthew A Fuller, Jennifer Ballard-Hernandez, James Sall, Richard Goldberg, James T Reston, Shannon C Ford, Noosha Niv

{"title":"Pharmacological and Somatic Treatments for First-Episode Psychosis and Schizophrenia: Synopsis of the US Department of Veterans Affairs and US Department of Defense Clinical Practice Guidelines","authors":"Robert W Buchanan, Ira Katz, Fuad Issa, Rachael Coller, Matthew A Fuller, Jennifer Ballard-Hernandez, James Sall, Richard Goldberg, James T Reston, Shannon C Ford, Noosha Niv","doi":"10.1093/schbul/sbaf053","DOIUrl":null,"url":null,"abstract":"Background The Departments of Veterans Affairs (VA) and Defense (DOD) provide care each year for approximately 75,000 people with first-episode psychoses or schizophrenia, but neither has formal, evidence-based guidance for treating these conditions. Recognition of this gap, together with guidance from Congress, led the Departments to develop clinical practice guidelines for first-episode psychosis and schizophrenia. This synopsis summarizes the psychopharmacological and other somatic treatment recommendations. Study Design An interdisciplinary panel of VA and DOD mental health and primary care providers was created following methods specified by the VA/DOD Evidence-Based Practice Guideline Work Group. The panel formulated key questions that guided a comprehensive search of the intervention literature from November 2011 to December 2021, with evidence limited to findings from randomized clinical trials. Recommendations were based on evaluation of the evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methods. Study Results The VA/DOD guideline panel developed 15 pharmacological and somatic treatment recommendations, including those on antipsychotic medication use for the treatment of first-episode psychosis and schizophrenia, use of clozapine for treatment-resistant schizophrenia, treatment of clozapine non-responders, and side effect management. There was insufficient evidence to provide recommendations for or against the use of non-antipsychotic medications or somatic treatments to treat negative or cognitive symptoms. Conclusions The VA/DOD guideline panel developed 15 pharmacological and somatic treatment recommendations to promote optimal, evidence-based care for active service members and Veterans. However, there remain multiple treatment planning decision points for which there is a lack of data and/or effective treatments.","PeriodicalId":21530,"journal":{"name":"Schizophrenia Bulletin","volume":"51 1","pages":""},"PeriodicalIF":5.3000,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Schizophrenia Bulletin","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/schbul/sbaf053","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PSYCHIATRY","Score":null,"Total":0}

引用次数: 0

Abstract

Background The Departments of Veterans Affairs (VA) and Defense (DOD) provide care each year for approximately 75,000 people with first-episode psychoses or schizophrenia, but neither has formal, evidence-based guidance for treating these conditions. Recognition of this gap, together with guidance from Congress, led the Departments to develop clinical practice guidelines for first-episode psychosis and schizophrenia. This synopsis summarizes the psychopharmacological and other somatic treatment recommendations. Study Design An interdisciplinary panel of VA and DOD mental health and primary care providers was created following methods specified by the VA/DOD Evidence-Based Practice Guideline Work Group. The panel formulated key questions that guided a comprehensive search of the intervention literature from November 2011 to December 2021, with evidence limited to findings from randomized clinical trials. Recommendations were based on evaluation of the evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methods. Study Results The VA/DOD guideline panel developed 15 pharmacological and somatic treatment recommendations, including those on antipsychotic medication use for the treatment of first-episode psychosis and schizophrenia, use of clozapine for treatment-resistant schizophrenia, treatment of clozapine non-responders, and side effect management. There was insufficient evidence to provide recommendations for or against the use of non-antipsychotic medications or somatic treatments to treat negative or cognitive symptoms. Conclusions The VA/DOD guideline panel developed 15 pharmacological and somatic treatment recommendations to promote optimal, evidence-based care for active service members and Veterans. However, there remain multiple treatment planning decision points for which there is a lack of data and/or effective treatments.

查看原文本刊更多论文

首发精神病和精神分裂症的药理学和躯体治疗：美国退伍军人事务部和美国国防部临床实践指南摘要

退伍军人事务部（VA）和国防部（DOD）每年为大约75,000名首发精神病或精神分裂症患者提供护理，但两者都没有正式的、以证据为基础的治疗这些疾病的指南。认识到这一差距，加上国会的指导，促使各部门制定了首发精神病和精神分裂症的临床实践指南。本概要总结了精神药理学和其他躯体治疗建议。研究设计：根据VA/DOD循证实践指南工作组指定的方法，创建了一个由VA和DOD心理健康和初级保健提供者组成的跨学科小组。该小组制定了关键问题，指导对2011年11月至2021年12月期间的干预文献进行全面检索，证据仅限于随机临床试验的结果。建议是基于使用建议分级评估、发展和评价（GRADE）方法对证据进行评估。研究结果VA/DOD指南小组制定了15项药理学和躯体治疗建议，包括抗精神病药物用于治疗首发精神病和精神分裂症，氯氮平用于治疗难治性精神分裂症，氯氮平无反应的治疗以及副作用管理。没有足够的证据建议支持或反对使用非抗精神病药物或躯体治疗来治疗阴性或认知症状。VA/DOD指南小组制定了15项药理学和躯体治疗建议，以促进现役军人和退伍军人的最佳循证护理。然而，仍然存在多个治疗计划决策点，缺乏数据和/或有效的治疗方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Schizophrenia Bulletin 医学-精神病学

CiteScore

11.40

自引率

6.10%

发文量

163

审稿时长

4-8 weeks

期刊介绍： Schizophrenia Bulletin seeks to review recent developments and empirically based hypotheses regarding the etiology and treatment of schizophrenia. We view the field as broad and deep, and will publish new knowledge ranging from the molecular basis to social and cultural factors. We will give new emphasis to translational reports which simultaneously highlight basic neurobiological mechanisms and clinical manifestations. Some of the Bulletin content is invited as special features or manuscripts organized as a theme by special guest editors. Most pages of the Bulletin are devoted to unsolicited manuscripts of high quality that report original data or where we can provide a special venue for a major study or workshop report. Supplement issues are sometimes provided for manuscripts reporting from a recent conference.