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Treatment and management of schizophrenia 

Treatment and management of schizophrenia
Chapter:
Treatment and management of schizophrenia
Author(s):

D. G. Cunningham Owens

and E. C. Johnstone

DOI:
10.1093/med/9780199696758.003.0079
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date: 18 September 2019

The above might be interpreted as inferring that nothing much has changed in the treatment and management of schizophrenia, which remains a somewhat pessimistic, even unrewarding, area of therapeutic endeavour: one that is regressing far less moving on. This is far from our experience and the opposite of the impression we wish to create. Certainly, as far as drug treatments are concerned, no single agent or type of agent now seems more satisfactory across the board than any other, but the challenge to ‘atypicality’ as a valid subgrouping of antipsychotics does not limit options—rather it broadens them, restoring to the treatment repertoire the wide range of choices that is the key to individualized care planning. With psychosocial interventions, there does remain more work to be done in proving absolute efficacy and/or effectiveness and the relative place of each, but in service development and care planning, risk:benefit appraisal is sophisticated enough to encompass what has qualitative value as well as what is quantitatively proven. As in all branches of medicine where chronic and relapsing disease is encountered, restoring order on chaos, fostering engagement and lighting a way forward when none may be obvious are for the highest levels of skill, in which evidence-based practice can provide the direction but not yet the specific path. We are fortunate in now having available to us the greatest ever range of interventions to bring to the care of those who suffer from this most complex and fell disorder. None is comprehensive, all have limitations, but if we wish to provide quality care, care that accounts for the multifarious manifestations patients present, it is our duty to apply not only the experience of others but of ourselves too. There is no ‘quick fix’ in gaining competence in the treatment and management of schizophrenia—and, as yet, no curative ‘holy grail’ either. But there is, more than ever, the opportunity for clinicians to demonstrate real expertise in moulding the range of therapeutics now at our disposal. If that is not reason for medical optimism, what is!

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