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Effective Health Care Program

Topic Suggestion Description

Date submitted: November 17, 2014

Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

What is the efficacy and comparative effectiveness of pharmacological and nonpharmacological treatments for adults with schizophrenia What are the harms from pharmacological and nonpharmacological treatments for adults with schizophreniaWhat is the effectiveness of treatments to reduce the side effects of first line treatments What patient characteristics predict the effectiveness and harms of pharmacological and nonpharmacological treatments for adults with schizophrenia Examples of relevant patient characteristics would include demographic factors e.g. age sex raceethnicity socioeconomic status time since illness onset prior treatment history and degree of treatment resistance and cooccurring disorders e.g. medical substance use and other psychiatric disorders. Nonpharmacological treatments would include psychotherapy psychoeducation and other psychosocial interventions including multicomponent programs. It would also include nonpharmacological somatic therapies such as electroconvulsive therapy or transcranial magnetic stimulation if applicable. Outcome measures of interest would include improvements in socialoccupational functioning improvements in health related quality of life the proportion of patients who experience a response or a full remission the magnitude of reduction in target symptoms reductions in hospitalizations reductions in selfharm including suicide and suicide attempts reductions in agitation or aggressive behaviors changes in the status of cooccurring disorders and the proportion of patients who experience key harms with a given treatment. See recent AHRQ protocols on bipolar disorder major depressive disorder and use of atypical antipsychotics for typical harms to be assessed with psychotropic medications and nonpharmacological interventions.

Describe why this topic is important.

Schizophrenia affects approximately 7 of every 1000 individuals in the U.S. population McGrath et al. Epidemiol Rev. 306776. 2008 Messias et al. Psychiatr Clin North Am. 30332338 2007.. However the impact of this disorder is much greater in terms of years lost to disability. The incidence of schizophrenia peaks in early adulthood Messias et al. Psychiatr Clin North Am. 30332338 2007 van der Werf et al. Psychol Med. 441916 2014 and given the chronic nature of the illness for many individuals the long term impact is considerable. Rates of suicide are also elevated in individuals with schizophrenia with a lifetime risk of about 5 Palmer et al. Arch Gen Psychiatry 62324753 2005. Individuals with untreated psychosis may also be at a higher risk of violence to others particularly during an initial psychotic episode Nielssen et al. J Clin Psychiatry. 735e5807 2012. Over the past several decades there has been an increasing disparity in the lifespan and standardized mortality ratio of those with schizophrenia as compared to the general population McGrath et al. Epidemiol Rev. 306776. 2008 Laursen et al. Annu Rev Clin Psychol. 1042548 2014 with studies suggesting a difference in lifespan of up to 20 years Laursen et al. Annu Rev Clin Psychol. 1042548 2014. Some of this increase is related to a greater prevalence of cooccurring conditions such tobacco use. Other contributors include increased rates of diabetes hyperlipidemia and metabolic syndrome as a consequence of treatment with antipsychotic medications Mitchell et al. Schizophr Bull. 39230618 2013. In terms of health care costs there are significant increases in the rates of emergency visits hospitalizations and medication related costs for individuals with schizophrenia as compared to a demographically adjusted population without schizophrenia Fitch et al. Am Health Drug Benefits. 711826 2014. Nonadherence with outpatient antipsychotic treatment is a significant contributor to readmission Marcus and Olfson Schizophr Bull. 2008 Jan34117380. In addition to direct health care costs indirect costs and reductions in patients quality of life can be considerable Kennedy et al. Int Clin Psychopharmacol. 2926376 2014.. Evidence suggests that optimizing the selection of an antipsychotic medication for individuals with schizophrenia can reduce hospital readmissions and improve outcomes for patients Olfson et al. Psychiatr Serv. 6210113845 2011 Valevski et al. Int Clin Psychopharmacol. 27315964 2012. Use of clozapine in particular has been associated with significant benefits yet there is substantial geographic variability in its use Stroup et al. Psychiatr Serv. 65218692 2014.

How will an answer to your research question be used or help inform decisions for you or your group?

An uptodate evidencebased review of the efficacy and comparative effectiveness of treatments for schizophrenia would inform development of clinical practice guidelines aimed at optimizing clinical interventions and patient outcomes for individuals with schizophrenia.

The most recent practice guideline of the American Psychiatric Association was published in 2004 with an updated discussion of subsequent literature in 2009.

A substantial body of literature has been published since that time including studies of several newer antipsychotic medications. We anticipate that this review will result in modifications to current guideline recommendations and will improve care to patients.

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Professional society developer of clinical practice guidelines
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American Psychiatric Association
Please tell us how you heard about the Effective Health Care Program
The American Psychiatric Association has been aware of the Effective Health Care Program for a long time. We are now using the systematic reviews produced by the Effective Health Care Program for guideline development and we track the status of Effective Health Care Program projects that are under development through email alerts and frequent use of the Effective Health Care Program website.
Treatments for Adults with Schizophrenia