What are the recommended first-line pharmacological treatments for managing schizophrenia in adults?

Recommended first-line pharmacological treatments for managing schizophrenia in adults involve the use of oral antipsychotic medication.

NICE guidelines do not recommend a preference for any specific antipsychotic drug for first-line treatment, as most antipsychotics have similar efficacy. The choice of antipsychotic should be made collaboratively between the healthcare professional and the person with schizophrenia, considering the likely benefits and possible side effects, including metabolic, extrapyramidal, cardiovascular, hormonal, and other adverse effects.

Initial treatment should start with a dose at the lower end of the licensed range and be slowly titrated upwards within the recommended dose range. A trial of the medication at an optimum dosage should be carried out for 4 to 6 weeks to assess effectiveness and tolerability.

Psychological interventions such as family intervention and individual cognitive behavioural therapy (CBT) should be offered alongside antipsychotic medication for first-episode psychosis.

Clozapine is reserved for people who do not respond adequately to two other antipsychotic drugs.

Monitoring of physical health and side effects should be conducted regularly, especially during the first 12 months or until the person’s condition stabilises.

In summary, first-line pharmacological treatment is oral antipsychotic medication chosen based on individual factors and side effect profiles, combined with psychological therapies.

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