Opinion
Video
Best Practices for Schizophrenia Management
Panelists discuss how best practices involve starting with lower doses in older patients, considering long-term tolerability over acute symptom control, and potentially using xanomeline/trospium chloride as first-line treatment even for treatment-naive patients presenting with acute psychosis.
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The discussion outlines best practices for managing schizophrenia across different care settings, distinguishing between acute inpatient management and outpatient maintenance therapy. For acute psychotic episodes, higher medication doses may be necessary and appropriate in monitored inpatient settings, but outpatient management requires more conservative dosing strategies with emphasis on tolerability and adherence. The transition from acute to maintenance therapy often involves dose reduction while monitoring for symptom recurrence.
Treatment selection considerations include patient-specific factors such as age, medical comorbidities, and adverse effect tolerance. In Lila’s case, the recommendation involves dose reduction from 15 mg to 10 mg olanzapine, with 2-week follow-up to assess efficacy and tolerability. If breakthrough symptoms occur or adverse effects persist, medication switching becomes appropriate. The discussion emphasizes individualized treatment approaches based on patient response rather than rigid algorithmic protocols.
Early intervention principles advocate for using effective, well-tolerated treatments from diagnosis rather than requiring multiple medication failures. For treatment-naive patients presenting with first-episode psychosis, after appropriate medical clearance, xanomeline/trospium chloride represents a viable first-line option. This approach prioritizes long-term functional outcomes and quality of life rather than solely focusing on acute symptom control, recognizing that cardiovascular disease remains the leading cause of mortality in patients with schizophrenia.
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