Schizophrenia Algorithm

Question 1

Pharmacological treatment algorithms

Answer 1

Pharmacological Treatment Algorithm (Simple)

1. Start treatment
   • Initiate any antipsychotic monotherapy
   • Clozapine is excluded
   • Choice depends on patient-specific factors
   • Start at low dose and titrate

⸻

2. Assess response
   • After 4–6 weeks at an adequate therapeutic dose, reassess

If partial response:
• Continue therapy and reassess at 8 weeks

If no response or intolerable ADRs:
• Switch to another antipsychotic monotherapy (not clozapine)

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3. If symptoms resolve
   • Positive symptoms resolve first
   • Continue maintenance treatment for at least 18 months
   • Duration depends on case-by-case basis
   • Symptoms may wax and wane
   • Relapse rates are high if treatment is discontinued

⸻

4. If inadequate response continues
   • Partial response → consider combination therapy
   • Treatment-resistant schizophrenia
   (failure of 2 adequate antipsychotic trials) → Clozapine