Management of psychoses including schizophrenia
Overview
Although the evidence for management of psychoses in people with developmental disability is limited, management should follow that for the general population; see the Psychotropic guidelines. Additional considerations in people with developmental disability are discussed below. See also Principles of management of psychiatric disorders in people with developmental disability and Additional management considerations in children and adolescents.
Acute psychotic episode
For advice on treating an acute psychotic episode, see Treating a first psychotic episode. For advice on the setting for acute treatment of people with developmental disability, see Setting for acute treatment of a psychiatric disorder in a person with developmental disability.
Pharmacological management
The evidence for pharmacological management of psychoses in people with developmental disability is limited. Drug recommendations for the general population are appropriate (see the Psychotropic guidelines).
For general considerations when prescribing psychotropic drugs for people with developmental disability, see Pharmacological therapy for a psychiatric disorder in a person with developmental disability.
Additional considerations for the management of psychoses in people with developmental disability include:
- higher risk of movement adverse effects from psychotropics, including acute dystonias, akathisia, parkinsonism, tardive dyskinesia and neuroleptic malignant syndrome
- increased risk of metabolic adverse effects.
Avoid administration of an antipsychotic medication by depot injection when possible (unless the person has previously demonstrated tolerance to the drug).
Long-term health risks are associated with treatments for psychosis; these should be managed as for the general population (see Antipsychotic adverse effects). Tardive dyskinesia is more common in people with developmental disability. Screening for tardive dyskinesia should occur every 6 to 12 months.