Australian Treatment Guide
for Consumers and Carers
The Royal Australian and New Zealand College of Psychiatrists,
Key points about schizophrenia
Compiled by The Royal Australian and New Zealand College of Psychiatrists (RANZCP), this information and advice is based on current medical knowledge and practice as at
Diagnosis and beginning treatment
the date of publication. It is intended as a general guide only, and not as a substitute for individual medical advice. The RANZCP and its employees accept no responsibility
for any consequences arising from relying upon the information contained in this publication.
Psychological and psychosocial treatments
The Royal Australian and New Zealand College of Psychiatrists
Support and self help
309 La Trobe StreetMelbourne Victoria 3000
Appendix 1: Solving common treatment problems
AustraliaTelephone: (03) 9640 0646
Appendix 2: Medication guide
Facsimile: (03) 9642 5652
Appendix 3: Mental health care teams
Email: [email protected]
Appendix 4: Sources of information and support
Appendix 5: Common terms and acronyms
Appendix 6: Development of the guideline
Key points about schizophrenia
1 Schizophrenia is a mental illness about which
there is much stigma and misinformation. This
often causes people with schizophrenia and their
family additional distress.
The typical symptoms of schizophrenia involve
disorders of thinking, perception and motivation
that distort reality and cause changes in
3 Although it is likely that there is no single cause
of schizophrenia, current evidence supports the
belief that it is due to biological abnormalities of
4 Schizophrenia may develop very gradually, or it
may present abruptly.
5 The diagnosis of schizophrenia is best made by a
psychiatrist, and your family doctor can make a
referral for an assessment.
6 Modern treatments exist. New medications
are possibly more effective than the older
treatments, and are certainly more tolerable.
7 It is important for people with schizophrenia
and their families to establish a positive working
relationship with the treatment team, especially
as treatment is long term. Modern treatment
combines medication with education, family,
social and community support.
What is schizophrenia?
Schizophrenia is a poorly understood illness in the general community
because there is much misinformation and stigma associated with
it. A person with schizophrenia does not have multiple personalities.
This guide has been developed for adults and young people with,
Neither are people with schizophrenia inherently violent. When
or suspecting they have, schizophrenia, and for their families and
in a treatment program, they act like other people in the general
carers. It has been written to provide you with information about
schizophrenia and its treatment, based on the best research evidence.
Schizophrenia is one of a group of mental disorders known as
It is intended to be read for discussion with your health professional
psychoses. A person experiencing psychosis has a loss of contact with
in order to jointly plan your care.
reality. Psychosis is characterised by difficulties with thinking and can
As a person or a carer for someone with schizophrenia, you too can
include seeing or hearing things that other people cannot see or hear;
benefit from a guide about the best possible treatments. This guide
these experiences are called hallucinations.
covers early treatment, support and recovery.
Psychosis can also include holding beliefs that are very odd or not true.
There have been great advances in treatment in recent years.
These beliefs are called delusions. People with psychosis often feel
And there continues to be a lot of research into treatments for
that they want to withdraw from the outside world. Their energy and
schizophrenia. It is the responsibility of health professionals to ensure
emotions are affected. They may feel a loss of vitality. They may also
that they are up to date with current best-practice approaches for the
feel depressed or irritable.
illnesses their clients have. The newer treatments for schizophrenia are
the most effective yet, and provide much hope that a comprehensive
Who gets schizophrenia?
treatment approach will reduce the suffering that schizophrenia can
bring. Early management of the illness by individuals, their families
Anyone can get schizophrenia. Schizophrenia affects one in 100
and friends, and health professionals can achieve better long-term
people across all countries, socioeconomic groups and cultures.
Schizophrenia usually begins when people are aged between 15 and
25, although it can also emerge later in life. Men are slightly more
likely to develop schizophrenia than women, and men tend to have
an earlier onset.
What are the first signs that something
Symptoms vary from person to person, but commonly include:
Most people experience changes in behaviour and perception. When
Not feeling social
these occur together in the early stages they are called a ‘prodrome'.
The prodromal symptoms include:
Not feeling any emotions
• changes from normal behaviour such as worsening of usual work
or school performance
• social withdrawal
• emerging unusual beliefs
• changes in perception, such as experiencing brief instances of
hearing sounds not heard by others.
Difficulty making decisions
The prodromal period lasts approximately two years on average.
After this time, clearer symptoms of psychosis become evident. The
Difficulty interpreting others' emotions and motivations
prodrome is best thought of as a warning: a person experiencing a
Schizophrenia appears to come and go in cycles, worsening in periods
prodrome is not necessarily going to develop psychosis.
known as relapse, but improving or disappearing completely during
remission. People with schizophrenia can have periods of stable
What are the symptoms of
emotional health. However, during the acute or psychotic phase, when
delusions and hallucinations may occur or worsen, many have trouble
with everyday tasks such as thinking clearly, managing their feelings,
Health professionals talk about three main types of symptoms
solving problems, decision making and relating to family, friends or
associated with schizophrenia. These are positive symptoms, negative
symptoms and disorganised symptoms.
Positive symptoms are experiences that happen in addition to
What causes schizophrenia?
normal experience. These include symptoms such as hallucinations
(positive because they are additional perceptions).
It is now accepted that schizophrenia is a syndrome (cluster of
symptoms) produced by a complex change in brain functioning. This
Negative symptoms incorporate a loss or decrease in normal
change interferes with intellectual processes and produces unusual
functioning. They include experiences such as loss of pleasure or
experiences and emotional changes.
interest in normal activities, loss of motivation, and loss of interest in
The causes of schizophrenia are multiple. They involve a combination
of genetic risk factors and other contributors such as complications
Disorganised symptoms are those symptoms that reflect the
during pregnancy and early life, and almost certainly other problems
confusion caused within the brain.
with brain development during adolescence. It is probable that a
that people with schizophrenia are twice as likely to die from heart
different mix of causes can occur from person to person. While in
disease. This may be prevented by people with schizophrenia receiving
some people it is possible to show subtle structural changes in the
earlier interventions to reduce the likelihood of a fatal coronary
brain using tests such as magnetic resonance imaging (MRI) scans,
incident. Cancer is another disease where the potential for prevention
in most people the abnormality in the brain is a reversible functional
and early detection is often missed. People with schizophrenia are no
disturbance. This is why treatment with anti-psychotic medication
more likely than someone in the general community to develop cancer.
seems to restore normal central nervous system/brain functioning.
However, they are more likely to die from cancer as it is typically
While much research has been carried out in recent years, a great deal
discovered much later than cancer in the general population.
still needs to be learned about this complex disorder of the central
Some of the other health problems faced by those with schizophrenia
are a consequence of side effects of anti-psychotic medications. These
include diabetes, weight gain (which is a risk factor for poor health)
What other problems do people with
and cardiovascular problems in some people. All of these health
problems are manageable if identified and treated early.
It is important that people with schizophrenia have the same
People with schizophrenia may also face other problems. Anxiety
screening tests as others with their risk profile and in their age group.
and depression are very common. The rates of substance use
Additionally, people with schizophrenia can look after their own health
(cigarettes, alcohol and cannabis especially) can be up to ten times
by eating a nutritious and balanced diet, exercising regularly, and
higher than in the general community. Because symptoms, if left
seeking help to reduce use of cigarettes, alcohol and other drugs.
untreated, affect relationships, many people with schizophrenia are
single, and unemployment can be a problem. People can also have
accommodation problems and may withdraw from family and friends.
Isolation and loneliness can be common.
People with schizophrenia may need assistance for several problems
when seeking professional help. It is okay to ask for help for any of
these problems to reduce the stress of living with schizophrenia and
improve the chance of recovery.
The physical health of people with schizophrenia is often overlooked,
and as a group, people with schizophrenia tend to have worse
physical health than the general community. The good news is that
most of these health problems are preventable. Often physical health
is ignored due to a concentration of the individual, their carers and
clinicians on issues associated with mental health. Studies have shown
Diagnosis and beginning
showing signs of a prodrome who have never had an episode of
psychosis are encouraged to develop a relationship with a mental
health professional or a GP with knowledge of this prodromal period.
Individuals who have a parent or sibling with psychosis have more
How is schizophrenia diagnosed?
risk of developing schizophrenia. If there is any change in levels of
functioning at school or work, or if symptoms of depression or strange
There is currently no test for schizophrenia. However, your general
thinking occur, it is a good idea for these individuals to go to their
practitioner (GP) may want you to do some other medical tests to
GP or a psychiatrist to be thoroughly assessed. By being monitored
rule out other possible illnesses, both physical and mental, which
in this manner, if clear psychotic symptoms emerge (and there is no
have symptoms similar to those of schizophrenia. Getting a correct
guarantee that they will), early specific treatment is readily available.
diagnosis can be difficult because psychiatric diagnoses are still based
on descriptions of behaviour.
This can avoid the need for hospitalisation and minimise the impact
of a potential psychotic episode. Early intervention is vital for a
If you are afraid of seeking help and feel reluctant to describe your
symptoms or see a GP, remember that the earlier you get help, the
greater your chance of managing your illness.
Your GP may be familiar with schizophrenia. However, it is strongly
See your GP for information and referral to mental
advised that a psychiatrist who is more qualified and experienced in
health services in your area or visit headspace,
confirming the diagnosis and planning treatment is also consulted.
Australia's National Youth Mental Health
Foundation. Assessment and treatment at public
mental health centres is free. There are some early
intervention centres where young people can be
There is currently no cure for schizophrenia. However, many
comprehensively assessed (see Appendix 4). You can
treatments that aid recovery have been developed. Many people with
get a referral from your GP to see a psychiatrist for
schizophrenia remain vulnerable to relapse and may have sustained
an assessment and treatment, the fees for which are
disability. Despite this, good quality of life is possible, and with
subsidised through Medicare.
improvements in the quality of treatment and support, many people
Evidence from the Personal Assessment and Crisis
recover to lead full lives again.
Evaluation (a clinic for people at immediate risk of
developing psychosis) study in Melbourne indicates
Prevention: can the prodrome
that assessment and provision of low levels of
medication in the prodromal period may reduce the
The prodrome is the period before an acute episode of psychosis.
risk of eventual psychotic symptoms in some people.
It indicates that a psychotic episode may be about to occur. People
When receiving care through a public mental health service, it is
When should treatment begin?
usual practice to be allocated a case manager (sometimes called a
The sooner a person with schizophrenia gets help for their symptoms
key worker) and a psychiatrist, who make up the treating team. The
the better the chance they have of receiving effective treatment.
case manager organises the assessment, treatment plan and ongoing
Research shows that it is important to get help early! This applies to
treatment with you. This includes information and education for you
the first episode and to all subsequent episodes. In many locations a
and your family or partner, or carers. They can also arrange links to
specialist ‘early intervention team' will provide care during the first
other services such as community agencies, employment services,
episode and offer follow-up for the first year or two.
Centrelink and accommodation agencies. The treating team may also
The first task is for your clinician to undertake a thorough assessment
prepare the treatment plan, which encompasses all aspects of care:
to understand more about different aspects of your life, such as your
medication, psychotherapy, education, support and other treatment or
accommodation, finances, symptoms and physical health. A thorough
investigation is required to make sure that there is no underlying
In rural areas, your GP may play this role and contact specialist services
physical condition that may better account for your symptoms. Once
by telephone. In other cases, because of personal preference, or
a medical check has been completed, a referral can be made to an
because the illness is stable, some people will have their schizophrenia
appropriate mental health service or specialist. If there are significant
managed entirely by a GP.
social, cultural or religious issues that need to be considered in your
treatment, you should let your health care workers know.
How to advocate for improving your care
How is my care organised?
If you do not think that you are getting the level of care you should
It is important to understand the treatment system so that you can
be, do not be silent about your dissatisfaction. Approach your case
make it work the best way for you. Care from your GP alone in the
manager, or the clinic manager. If the problem is a lack of resources,
first onset of schizophrenia is not an adequate standard of care. You
approach members of parliament or become involved in a consumer
need a GP who can advise you about when you should see a mental
or carer network. Ask to speak with the consumer consultant and/or
health professional and to help you get specialist care early. You can
carer consultant in your mental health service. If there is not one, ask
receive specialist care in the public mental health system or from a
why not. If you are seeing a private psychiatrist and are not happy
with your care, ask for a second opinion, or discuss referral to a
In situations where the person does not believe they are unwell, it is
different psychiatrist with your GP.
often the family who goes to the GP seeking assistance. GPs typically
give families the contact details of the mobile assertive outreach (a
specialist team of mental health workers) from the local mental health
service so that a home visit can be made to determine a plan of action.
Location of treatment
• treatment provided in a particular setting (you may have a
cultural preference for home or hospital treatment)
A range of treatment settings is available and the choice of which
• special food or access to a prayer room if you need to go
one to use is made on the basis of the nature of your illness. Where
possible, people with schizophrenia are treated in the community (as
• understanding of your family's expectations of treatment.
opposed to becoming inpatients in a hospital) to reduce the distress
and disruption to their lives. The treating team may visit you at home,
It is very important to discuss cultural issues with your health care
and can support you in crisis situations.
provider, to enable them to better understand you and so that your
religious beliefs and cultural practices can be incorporated into your
If you are in recovery or remission, you can attend regular outpatient
appointments for treatment. However, if you are at risk of harming
yourself or others, or if you are extremely distressed by your
What does treatment cost?
symptoms, the best option may be a short stay in hospital for
treatment and care. Sometimes this may be necessary even though it
It is important to discuss all potential costs involved in your treatment
may not be what you want at the time.
with your health professional.
When you are well, arrangements for what will happen in the event
In Australia, some GPs bulk bill, which means that Medicare will
of a relapse can be put in place in advance. This gives you more
cover the full cost of any visit. If your GP does not bulk bill, partial
control and you will have a say in how you would like to be treated.
rebates are available through Medicare and you will need to pay any
difference. There will also be an additional cost for any medication
that may be prescribed.
Your GP may refer you to appropriate services, such as for
Health professionals should always respect and cater for the wide
psychological services provided by a psychologist or an appropriately
diversity of cultural groups in our community. Depending on your
trained social worker or occupational therapist. Any treatment
cultural background or religious beliefs, when you are seeking
provided by these health professionals will only be rebated by
treatment, or helping a person you care for get treatment, you may
Medicare if you have previously claimed a rebate for a GP Mental
have special requirements that you need to communicate to the
Health Treatment Plan. A GP Mental Health Treatment Plan will be
health professionals you encounter. You may need to request:
developed by your GP and tailored to your needs to find the treatment
• a translator if your first language or that of the person you care
that is right for you, monitor your progress and assist you in achieving
for is not English
your goals for recovery.
• explanations of medical or other terms that may not be clear
Medicare rebates are also available for assessment and treatment by a
• respect for your religious practices and understanding of the roles
psychiatrist. A psychiatrist may also refer you for Medicare-subsidised
of males and females in your culture
treatment with a psychologist, an appropriately trained social worker
or occupational therapist. You may receive up to 12 individual/and or
group therapy sessions in a year. An additional six individual sessions
The main types of medicines used to treat schizophrenia are called
may be available in exceptional circumstances.
anti-psychotics. There are two groups of anti-psychotics. The older
Your GP may also refer you to other government funded providers of
group, referred to as ‘typical' anti-psychotics, include chlorpromazine,
psychological services depending on what is available in your
haloperidol and thioridazine. The newer group are called ‘atypical'
anti-psychotics. These include olanzapine, risperidone, clozapine,
quetiapine and amisulpride. Older medications work, but often have
How is schizophrenia treated?
more side effects, especially if used in high doses.
Treatment should include medication, psychological and psychosocial
Information on the safe dosage range for your
treatment, and community support. The combination of treatments
medication can be found in the product information,
is crucial and all forms of treatment enhance each other to produce a
or in standard manuals of medication such as MIMS
better recovery for the individual.
or the Therapeutic Guidelines – Psychotropics (which
Psychosocial rehabilitation enhances the effects of the anti-psychotic
most GPs hold). Ask your GP if you can read the
medication whilst the medication also enhances the effects of
section about your medication. You will typically
rehabilitation. Social inclusion is as important as medication as it treats
be given written information on the medication
the person rather than merely the disability. An individual's motivation
prescribed for your treatment, including any side
to get better is critical to their recovery. As you progress through your
effects that may occur.
treatment, exercising regularly and eating a healthy diet can help you
gain a sense of mental health and wellbeing.
Does medication work?
All of the medications that may be prescribed for you have gone
through rigorous international testing, and have been shown to
reduce the symptoms of psychosis. They are not addictive. There
are several types of medication and your psychiatrist will choose the
one that will best address your individual symptoms. You should
Medication is essential for effective treatment of schizophrenia for
ask why the particular medication has been suggested for you. In
most people. However, it works best when integrated with good
recommended doses, anti-psychotic medication is safe. However,
quality psychosocial treatment.
excessive doses can result in a range of disturbing side effects.
It is necessary to find the right type and dosage of medication to
Sometimes it takes time to find the most effective medication
treat your symptoms with the fewest side effects. Generally, a single
medication will be used. However, in some cases it may be helpful to
It is very important to communicate any changes in your symptoms
What symptoms are helped by medication?
or new symptoms to your doctor as these may be side effects of your
The positive/active symptoms of psychosis, such as hallucinations and
medication. Appendix 2 gives a summary guide to medication and side
delusions, have been the main focus of medication treatment. Newer
effects with space for you to record your medication dosage.
anti-psychotic medication may also be helpful in treating negative/deficit
symptoms, particularly problems with mood, thinking and socialising.
Common side effects
Feelings of anxiety and agitation are also helped by anti-psychotic
Movement disorders, sometimes referred to as extrapyramidal
symptoms, are known side effects of anti-psychotic medications and
are more common with the older anti-psychotics, known as typical
Does medication work for everyone?
anti-psychotics. Movement disorders include tardive dyskinesia
(see below), dystonia (muscle spasm), Parkinsonism (tremor, slow
A small number of people do not respond well to initial treatment and
movements), and akathesia (restlessness).
may need to try several anti-psychotic medications as well as other
therapies to gain control over their symptoms. For people who begin
The newer, or atypical anti-psychotics, have been found in studies to
treatment with one of the newer anti-psychotic medications, known as
be effective at treating symptoms of schizophrenia, and typically cause
atypical anti-psychotics, and find their symptoms do not improve, the
fewer side effects, including effects on muscle tone and movement.
medication clozapine has been found to be effective.
They are, however, more likely to cause other specific symptoms
including weight gain, loss of libido, and hormonal side effects.
Relapse prevention and medication
Weight gain is a relatively common side effect of some anti-psychotic
medications, in particular the newer atypical medications olanzapine
Individuals who have experienced a psychotic episode need to consult
and quetiapine. While weight gain itself does not usually mean there
their GP or psychiatrist and case manager for strategies to prevent a
is a more serious underlying metabolic problem, significantly increased
further episode. This may include restarting or increasing medication,
weight may put some people at greater risk of developing other health
or adding a different medication in combination with psychosocial
problems such as diabetes and cardiovascular disease.
treatment and regular monitoring. Becoming involved in a psychosocial
rehabilitation program will also help to prevent relapse.
Other possible side effects of anti-psychotic medications include
dizziness (especially on standing), sedation, and, rarely, liver disorder.
A small number of people taking anti-psychotic medications may
What are the possible side effects?
also experience symptoms linked to changes in hormone levels, such
You may experience side effects when taking anti-psychotics. Some
as breast changes, galactorrhea (stimulation of milk secretions) and
common side effects or side effects about which it is important to
sexual dysfunction in males.
be aware are discussed below. You may wish to ask your doctor or
No one should have to put up with unpleasant side effects. Doctors
pharmacist for more detailed information on the side effects of any
can treat these effects by using low doses of anti-psychotics or
medication you may be taking.
prescribing medicines to reduce movement symptoms.
agranulocytosis (loss of production of white blood cells). Agranulocytosis
can lead to an increased chance of experiencing life-threatening infections.
Tardive dyskinesia (sometimes referred to by the acronym TD) is a
To prevent this, you need to have a weekly assessment of your white cell
particular movement disorder that can occur with anti-psychotic
level when you commence this medication and then ongoing monthly
medication. Tardive dyskinesia involves uncontrollable muscle spasms
resulting in a twisting of the body or neck. Tardive dyskinesia can
occur in up to 5% of patients who take typical anti-psychotics over
Risperidone in low doses has very few side effects. In higher doses,
a long period of time. Recent research has shown that the newer,
some movement disorder side effects have been noted. People who take
or atypical, anti-psychotics are much less likely than the typical anti-
risperidone have also reported weight gain, some gastric discomfort, and
psychotic medications to cause tardive dyskinesia.
Olanzapine generally has few side effects, but may cause weight gain
and has also been associated with other non-movement disorder side
If you are unhappy with your medication, provide
effects such as constipation, sexual dysfunction, and possible mild liver
your clinician with as much information as possible
about your symptoms, side effects and other
problems. You have a right to expect the best
Quetiapine has been associated with side effects such as drowsiness,
weight gain, dizziness and headaches, but there is a significantly lower
incidence of distressing symptoms such as movement disorder symptoms
Take all medications as prescribed.
If a medication works well, stick with it. Don't chop
Amisulpride may cause side effects including weight gain and
drowsiness. Amisulpride, when compared to other anti-psychotics, may be
These medications take a little while to start
more likely to cause changes in the breast such as increased milk flow and
working. Don't stop taking your medication unless
changes in males, although these changes are very rare.
under good medical supervision.
On the other hand, amisulpride may be less likely than other anti-psychotic
medications to cause sedation and movement disorder side effects.
Talk to your doctor about the advantages and disadvantages of using
Individual drugs and their side effects
these newer medications, particularly the possible impact of side effects.
Clozapine may cause fatigue, drowsiness, constipation, and weight
gain. It has also been associated with increased heart rate, seizures,
What is the treatment for side effects?
increased saliva production and problems with urination. A small
proportion of people who take Clozapine may also experience
To treat movement disorders caused by older anti-psychotics, doctors
changes in their white blood cells (which are involved in defending
often use a medication called an anti-cholinergic, such as benzotropine
the body from infection) and there is a small chance (less than 1%) of
(Cogentin, Benztrop). Anti-cholinergic medications may also cause side
effects including sedation, dry mouth, constipation, and impaired
What is depot medication?
memory. Many side effects, such as sedation, will improve with time.
Depot medication can be useful for some people, at least for a period
If side effects continue to cause problems it may be necessary to
of time. Depot medication is a form of anti-psychotic medication given
change the dose, use a different type of anti-cholinergic, or add
by injection, which slowly releases the medication over one to four
weeks (depending on which medication is given).
For weight gain, some people are able to monitor their weight and
Most of the depot formulations currently available are for the typical
effectively self-manage this troubling side effect by eating healthily
anti-psychotics but depot versions of some of the newer atypical
and exercising regularly. Some mental health services offer weight
anti-psychotics are becoming available. A doctor or nurse will usually
management clinics for people taking anti-psychotic medications.
give the injection. Some people prefer depot medication as they find
Alternatively they can provide referrals to dietitians to support people
remembering to take pills every day difficult. However, depot medication
taking anti-psychotic medications who are having difficultly managing
can cause the same side effects as mentioned above for
their weight. Talk to your mental health service about what support
these medications when taken in oral form.
might be available in your local area.
Sometimes people with schizophrenia are ordered to take medication
Constipation is another troubling side effect that if mild to moderate
under government laws such as the Mental Health Act. In this situation,
can be effectively self-managed by increasing fluid intake, eating
depot medication is often used. An order to be treated and to take
plenty of fibre rich foods, and, if necessary, the occasional use of mild
medication made under mental health legislation must be reviewed at
laxatives. Persistent or severe constipation should be discussed with
regular intervals. There is also provision for you to appeal against any
your mental health professional.
Remember to mention any unusual symptoms or side effects
you experience to your doctor. Rare but more serious side effects
Why do I have to take other medications?
require urgent medical attention. Your doctor can provide you with
Your GP or psychiatrist may consider prescribing other medications along
information on what to look out for. Medicine information leaflets,
with an anti-psychotic medication to treat the symptoms of schizophrenia
usually found inside the medication packet or available from your
or other problems you may be having. There are many medications that
doctor or pharmacist, also provide information on side effects.
may be used in conjunction with anti-psychotic medication. They include:
• anti-anxiety agents, which are used to treat distress or agitation
If you experience anything which may be a side
• mood-stabilising agents to treat mood symptoms when they occur
effect, tell your doctor as soon as possible. It may be
in psychosis (lithium, carbamazapine and sodium valproate)
that the symptom you are experiencing is not a side
• sleeping tablets (hypnotics) to help insomnia
effect, but it is better to be sure.
• side effect medication (anti-cholinergics, or anti-parkinsonian
medications) used to reduce movement disorders
• anti-depressants used to treat depression.
There are a number of points to consider. Accepting the need for
How much do I need?
regular medication can be daunting for anyone. If you think of the
Anti-psychotic medications are administered at the dosage that proves
challenge it can be to take a full course of antibiotics for two weeks,
most effective for each individual. For many medications, the doctor
it is a much bigger challenge to take an anti-psychotic and side effect
will start with a low dose and increase very slowly to reach the level
medication for a much longer period of time.
where symptoms stop and before side effects start to be present.
Taking medications long term requires some lifestyle changes, similar
Doses differ according to the potency of the medication used and
to those required for managing any long-term condition such as
cannot easily be compared against one another.
arthritis or diabetes. Making lifestyle and mindset changes is not easy.
For example, 100 milligrams (mg) of chlorpromazine is approximately
Medications are often incorrectly seen as mind altering rather
than mind restoring.
• 2mg of haloperidol
Taking the medications can cause unpleasant experiences such as
• 2mg of risperidone
sedation, ‘numbing' or slowed down thinking, movement or body
• 7.5 to 10mg of olanzapine.
problems, or sexual side effects. As a result, many people form the
incorrect view that the medications are ‘mind altering' rather than
For how long do I need to take the
Seeing your medication as mind restoring can help maintain your
motivation to keep taking it. Medications are a very powerful
Some people will require anti-psychotic medication for long periods.
protector against a second or further breakdown. Taking medication
Usually the medication is continued for one to two years after the
as it is prescribed makes it five times less likely that you will experience
person has achieved excellent recovery from their first episode,
a relapse. Sometimes it takes more than one psychotic episode for
and has been able to maintain stable relationships, work and
people to accept that medication is necessary.
In the early years there is a high risk of relapse and if the person
If you are put on an order to receive treatment, you
experiences another episode they may need anti-psychotic medication
should be given a booklet that outlines your rights.
for two to five years before ceasing use. Those who have multiple
If are not given this booklet, it is important that
episodes may need to use medication for much of their life.
you ask for it. If you are unable to read the booklet,
your rights should be explained to you verbally or
an appropriate translation should be provided.
What if the medications don't work
Psychological and psychosocial
If you have tried one or two anti-psychotic medications and your
symptoms have not improved, a thorough review is necessary. First
Psychosocial treatments should be tailored to your individual needs.
your doctor will typically check with you that you remembered to take
Medications aim to reduce your symptoms while psychosocial
the medication as prescribed and that the dose was correct, and that
treatment helps you adapt to living with schizophrenia and helps you
there are no other factors involved, such as a medical problem or use
to strive for a good quality of life, despite the illness. One important
of cannabis or other drugs.
feature of all psychosocial treatment is developing a relationship with
Your doctor may suggest that you try psychological therapy, described
your health professional that is based on trust and optimism. Ideally
below, to help you cope with the symptoms, and that other medicines
this would also extend to your family, partner or carer.
be added to help. A third atypical medication may be tried. More
There are several kinds of psychosocial treatment that may benefit
commonly, you would be offered clozapine, a medication showing
good results when other treatments are not successful. However, if
you are taking clozapine you will need to be closely monitored for
This therapy provides education to individuals and their carers about
What about pregnancy and
the illness, either individually or in a group. It works by increasing your
understanding of symptoms and treatment options, services available
and recovery patterns. Information and education may be provided
Many anti-psychotic medications have not been tested on pregnant
via DVDs, pamphlets, websites, meetings, or discussions with your
women. Unborn babies are very sensitive to medications and it is
case manager or doctor. If required, information in other languages
very important to talk to your doctor about the safest choices to
or interpreters can usually be provided to you. Materials can also be
use during pregnancy and/or breastfeeding. An observational study
obtained from support groups as listed in Appendix 4.
– The National Register of Antipsychotic Medication in Pregnancy – is
designed to collect information about anti-psychotic medication safety
in pregnancy. Early results from this continuing study suggest that the
People with schizophrenia should be encouraged to nominate a friend,
most commonly used anti-psychotics are reasonably safe for use in
their partner or other family members who will help and support them
pregnancy, but that the need for the medication has to be considered
for as long as is necessary. Help and support is particularly necessary
carefully. Further information can be obtained by contacting Professor
when people become unwell and may turn against those closest
Kulkarni at The Alfred Psychiatry Research Centre, Commercial Rd,
People with schizophrenia and their supporters (usually family
‘I am not sick! I don't need help!'
members) can be helped by undertaking a program of family
A percentage of people who develop schizophrenia are unaware that
psychoeducation to help them build skills they need to provide
they have an illness. This creates challenges for everybody. The book I
ongoing support for the person with schizophrenia.
am not sick! I don't need help! by Xavier Amador (author) and Anna-
Family psychoeducation is a program delivered for at least nine
Lica Johanson (contributor) is a practical guide for families.
months, in which the person with schizophrenia and family members
Support groups are designed for patients and families to share their
are helped by clinicians to learn communication and problem-solving
experiences about services or treatment. Research shows that support
skills to solve the many challenges that accompany schizophrenia.
groups can be helpful. Sometimes your family may be able to help you
Positive research evidence for these programs indicates that relapse
in other ways. For example, family members can:
rates are reduced, resulting in fewer hospitalisations and greater
• help you identify early warning signs
willingness to take medication, thereby resulting in a reduction
• keep records of the effectiveness of medication at treating
of psychiatric symptoms. Other outcomes include improved social
functioning, increased employment rates, involvement in the
• assist you in accessing care.
community, reduced burden for carers, and significantly improved
relationships within the family. These programs would ideally be
They can also play an important role in encouraging and supporting
included as routine care but are not yet widely available. Strong
you to return to social, academic and vocational activities.
advocacy is needed to increase their availability.
If an organised family psychoeducation program is not available, your
Cognitive behavioural therapy
family and friends will still want to talk to a professional about their
One form of psychotherapy that has been found to be effective in
experience of your illness and how they might help. It can be very
treating psychosis is called cognitive behavioural therapy (CBT). It may
distressing to see someone you love and care for become unwell. Your
be recommended depending on your needs and phase of illness.
family can be an important source of information to help in clarifying
Research suggests that CBT can improve coping strategies, help you
your diagnosis, and in supporting your treatment.
learn new ways to manage stressful situations, improve thinking and
Good communication exists when you, your family and your clinicians
memory skills, help you learn to socialise, reduce the level of positive
talk about the choice of treatments so that everyone receives the same
symptoms, and help manage ongoing symptoms.
information and can work towards the same goal.
Research has also shown that CBT is a useful treatment for symptoms
Clinicians should offer your family members or carers frequent support
of depression and anxiety. These symptoms are very common in
when you are acutely unwell, and on an ongoing basis as needed.
people going through a psychotic episode. CBT may also be effective
You should ask for printed information on your medication, therapy or
in reducing drug abuse.
group activity that you can give to your family members or partner.
It is also more common for people experiencing psychosis to have
suicidal thoughts and feelings. They are at a greater risk than the
People with schizophrenia may benefit from participating in group
general community of self-harm and suicide. This risk can be reduced
activities with other people who also have schizophrenia. The focus
through supportive psychotherapy and use of expertly conducted
of these groups can vary. They may provide information, teach coping
CBT. CBT works by reducing the severity of depressive thoughts and
skills for dealing with mental illness, provide opportunities for formal
feelings of hopelessness that can be experienced by some people
or informal exercise, help you to develop relationships, help you
to learn to become independent again, improve your confidence,
It is important to ask your mental health professional if they have
enhance your study or work skills, or just be fun.
special training in CBT.
If your mental health service does not run such groups, your doctor
or case manager can let you know about groups run by local
Vocational and social rehabilitation
Rehabilitation focuses on social and occupational skills, which may
be absent or underdeveloped due to your illness. Depending on your
Overstimulation and feeling under pressure can
needs, rehabilitation can be undertaken in a group or individually.
lead to relapse. Isolation and loneliness are related
It's about getting your whole life back and not just managing
to poorer and slower recovery. Group activities
organised by clinicians or in local community groups
When a person becomes ill, it is helpful for others to focus on their
can counteract these problems. Join a group. Get
strengths and not dwell on their mental illness. By focussing on a
person's strengths, these strengths are reinforced and they will feel
more validated as a person. They will feel they have greater meaning
and purpose, and will not feel subsumed by their illness. It is important
to also remember that a person's key strengths may relate to them as
Self-help groups are not really considered ‘treatment'. Rather, they
individuals, or to them as a member of their family or community.
are there for support and information. They may be beneficial because
they provide support, facilitate information exchange, and provide
Emphasising and reinforcing the positive aspects of a person's life will
help them to retain a sense of hope and be more able to positively
manage their mental illness. Seeing a person with mental illness as a
Often self-help groups provide opportunities for developing new
person rather than focussing on their illness can contribute to their
friendships. A list of self-help agencies is included in Appendix 4.
wellbeing and to a more sustainable recovery.
Self-help groups may also work to foster understanding of people
with schizophrenia by the wider community. They can also give you
the chance to help someone else who is recovering because you may
benefit from hearing each other's experience.
Advocacy is important. There is much known about the optimal
Depression can be overcome. Most people have a good recovery even
treatments for psychosis, however, access to these optimal treatments
if things have been a bit rocky for a while. The key steps to surviving
is not always as easy as it should be. Through self-help groups you can
depression and suicidal thoughts in schizophrenia are:
lobby for better services and more research.
• tell someone – your doctor, case manager, relatives, friends
• seek help – your doctor or case manager can help you manage
your low feelings
A system of mobile clinical support is available in most areas 24 hours
• don't be alone – keep company around you and perform some
a day. Public mental health crisis assessment teams (CAT teams) are
trained mental health professionals linked with your local service who
can speak with you over the phone about your situation, current
treatment and symptoms and, when necessary, visit you or arrange
Remember that research shows that combined
follow-up with your treating team. It should be part of your regular
treatments work best, rather than choosing only
treatment plan that you know how to contact the after-hours service
one treatment. It is important to choose both
when you feel at risk. Ensure that you have the contact details of the
medication and psychosocial treatments together
service. These details can also be obtained from your case manager or
to progress your recovery.
doctor. Family members can also use the service.
Talking to someone is an important part of treatment. Your case
manager and doctor can provide general counselling and support
during and after an episode of psychosis.
If you are feeling down, depressed, demoralised or thinking about
suicide, it is VITAL that you talk to someone about it.
When is hospitalisation necessary?
A range of treatment settings should be available to people with
Coping with the bad times
schizophrenia. Treatment should occur in the least restrictive
Suicidal thinking is temporary, but it is dangerous to try to cope with
environment possible and hospitals used only when absolutely
these symptoms on your own.
necessary. Hospital inpatient care may be appropriate when you need
a place away from major stressors, or when medications need major
Suicide is one of the main causes of death for people with
review or other treatments are needed that can only be delivered
schizophrenia, most likely due to the depressive symptoms that many
people experience, especially early on in their psychosis.
Where possible, people should be treated at home. Sometimes
Support and self help
hospitalisation is necessary for your safety, even though you do not
want it. Involuntary hospitalisation is governed by the Mental Health
Act. Like orders to receive other forms of psychiatric treatment, an
order for involuntary hospitalisation should be regularly reviewed, and
Families, loved ones and friends
you should be informed in writing of your rights.
Schizophrenia is an illness that not only affects those who have it,
Going to hospital can be a distressing experience. Everybody has ideas
but also their families, loved ones and friends. Often those close to
about what a psychiatric ward will be like. Most of these ideas are
a person experiencing schizophrenia are confused and unsure about
based on outdated stereotypes, and fiction. You have a right to be
the illness and their role in recovery. This can particularly be the case
treated with respect and to have things explained to you in a way and
where the person experiencing psychosis may have ideas that make
language you understand. You can ask for family or friends to stay
them afraid or distrustful of their family. In this situation it is often
with you while you are admitted and get settled in.
difficult for clinicians to make decisions about sharing information,
Hospitalisation should also offer access to non-medication treatment
particularly if the person states unequivocally that family members are
options such as those discussed previously. Your family or friends can
not to be involved.
visit and spend as much time with you as you wish, while you stay
While it is important to remember that the primary concern of
clinicians will be the person experiencing the illness, families need
to give information about what has been happening, and to receive
Rarely, electroconvulsive therapy (ECT) is used if you have severe
information. This may take the form of education about the illness in
depression on top of your schizophrenia or when symptoms are
general, or more detailed information about their loved one's specific
very severe. ECT can be effective. It is not painful, and there are no
circumstances. Family members need information about how to
long-term effects. If ECT is recommended as a treatment for you, a
manage, as they often fear that they may inadvertently do things that
brochure should be provided to you explaining how it works, how it
feels and your rights. ECT is administered in hospital.
It is also helpful if the clinician clearly explains to the person
experiencing psychosis that it is in their best interests if the family
Be optimistic about your future. You can live well
carers are involved as they can be an essential element in recovery. The
with, and after having had, schizophrenia!
clinician will need to reassure the person that their private information
will not be disclosed. In cases where information cannot be given by
the treating clinician, family members can seek help from another
clinician not directly involved in the treatment program, who could
give the family carers the information and support that they require.
Getting the most from visits with
and help you. Pay attention to changes in your body and in your thinking,
and report them as soon as you can to your treating team.
It is very important for you to collaborate with your doctor to find a
Sometimes in an appointment, people forget the questions they want
medication that gives you the most benefit, and use it as recommended.
to ask, or do not remember what the answers were, so it is a good
idea to prepare for the appointment beforehand.
It is wise to develop a plan to monitor early signs of relapse. You may
want to ask close friends or family to help. Start the plan as early in the
• Write down specific questions for discussion and take them
development of the illness as possible.
• Take a notebook and pen, and write down the answers given to
Finally, it is important to nurture all the positive relationships you have in
you by your clinician.
your life to ensure you have support throughout treatment and a positive
• Take a friend or family member with you to appointments.
outlook for the future.
• Ask your health professional to explain any terms that you
Research summary of treatment essentials
You could also write a letter to your clinician outlining your queries
Essentials for treatment are:
and requesting a written response.
• combined medication and psychosocial therapies
• low dose atypical anti-psychotic medication is
What can I do to help myself?
strongly recommended unless there are indications
You can contribute by staying informed about schizophrenia and its
for other medication
treatments. Tips for good health practices include:
• adjunctive medications where required
• psychoeducation for individuals
• following a sensible diet
• collaboration and education for families and carers
• having regular exercise
• individual cognitive therapy and group therapy
• avoiding all illicit drugs, as they have a strong negative impact
tailored to individual needs
• access to crisis support 24 hours a day
• not using tobacco, as for all individuals, as it acts on the liver and
• case management and other agencies providing
may mean higher doses of medication are required
accommodation and vocational support.
• using alcohol and caffeine moderately
• developing good sleeping habits
There should also be a focus on the future, and where
• learning and using stress management techniques.
you are going. Case management should be pro-active.
If it is not, then you need to demand that it is.
Try and build an honest and open relationship with the professionals
involved in your care. This will make it easier for them to understand
Solving common treatment problems
The table below outlines some common problems you may encounter
during your treatment, and offers some possible solutions.
A Excess medication
Inform nurse or doctor of side effects. Dosage
D Negative attitudes
may be reduced, medication changed to a
different anti-psychotic or another medication
i. Mental health
If you perceive poor attitudes from a member
added to counter side effects.
of the mental health services, in the first
instance speak to that person's manager (e.g.
shift leader, charge nurse, clinic manager) or
Provision of counselling by mental health
to a member of your treatment team you feel
admission – e.g.
service, preferably with a staff member not
you can talk to. You could also speak to the
you were brought
associated with the trauma. Also, a similar
consumer consultant in your service who is
service could be provided to relatives who may
there to advocate for you.
by police and/or
have been traumatised by your admission.
Many people in the general public are
uneducated about mental illness. Where
possible find people who will support you to
C Scary inpatient
You have a right to feel safe in hospital. If
‘speak out'. Tell your clinician about the way
you do not, you should speak to staff about
you feel. If you experience attitudes that seem
your concerns. You may be placed in a locked
like discrimination or harassment, e.g. at your
ward as a safety precaution. This situation has
accommodation, or workplace, then find pro
to be reviewed regularly, and you should be
bono lawyers who will help you take action.
informed of why you are still in a locked ward.
It is illegal to discriminate against someone
because of mental illness.
E Low skill care
You should receive care from professionals
G Barriers to
who are up to date in their knowledge of
psychosis and schizophrenia. Check out their
i. First episode
Problems in getting access to quality services
qualifications. Membership of a professional
for a first episode are beginning to be
association may indicate that they are required
addressed by the development of specialist
to keep up to date. Ask questions such as:
early intervention centres or teams within
What are the qualifications of the clinician?
existing services. Ask what special approaches
What is their experience in working with
are available in your area. Sometimes there
people with psychosis? How do they keep
are barriers when you want help but you are
their knowledge up to date? (Answers you
told that you are not unwell enough. In this
will want are reading journals, attending
case, talk to your doctor and try together to
conferences, and attending courses.) Are they
get access. It is important to reduce the delay
a member of a professional association such as
in receiving care as the earlier treatment is
the Royal Australian and New Zealand College
started, the better the outcome. A private
of Psychiatrists, the Australian Psychological
psychiatrist or self-help group can also be
Society or the Australian Association of Social
People experiencing a relapse may also
experience difficulties accessing mental health
F No psychosocial
The aim of a mental health service should
services. The difficulty can be minimised by
be to provide a comprehensive, best practice
having a plan worked out in advance with
service. It is known that a psychosocial
your clinicians and carers.
recovery program is an integral part of an
optimal rehabilitation. Ask for the types
Sometimes people who are unwell with
of programs or activities that have been
schizophrenia feel that they don't need
mentioned in this guide. Again, advocate for
or want treatment. This is another barrier
to receiving services. Often mental health services will say that they are not able to force treatment on someone who is not ‘at risk' (i.e. imminently suicidal/homicidal). However, this is not absolutely true. If you are a carer, a good suggestion would be to become familiar with the Mental Health Act in your area. This will help you to advocate for care when it is needed.
Usual therapeutic doses and intensity of common side effects of
Usual therapeutic doses and intensity of common side effects of
long-acting traditional anti-psychotics.1
Range (mg) Sedation
Cholinergic pyramidal Gain
Range (mg)4 (weeks) Sedation
Cholinergic pyramidal Gain
IC Amisulpride 100-1000 + + 0 ++2 +
++(initial y) +++(initial y) 0
++(initial y) +++(initial y) 0
1 Based on the Therapeutic Guidelines (Psychotropic)
Version 5 publication.
Negligible or absent
2 Rarely a problem at usual therapeutic doses.
++ Moderately frequent
Single dose, not to be repeated for two or three days.
4 An initial test dose is recommended for all long acting
IM Intramuscular (i.e.
agents, especially if the person with schizophrenia has not
injected into a muscle)
been exposed to the type of anti-psychotic agent previously.
5 Patients switched from zuclopenthixol acetate do not require
a test dose of zuclopenthixol decanoate.
Dosages vary from person to person. It is recommended
that you discuss this guide with your doctor in relation to
your prescribed dosage.
Psychiatrist – A medical doctor who specialised in psychiatry.
Psychiatry is a branch of medicine that deals with the study, treatment
and prevention of mental illness and the promotion of mental health.
Psychiatry registrar - A registered medical doctor doing specialist
Mental health care teams
training to be a psychiatrist.
Crisis team member – Mental health professionals from a wide range
Psychologist – A person usually trained at a post-graduate level
of professions who work in teams to provide assistance during periods
who works to apply psychological principles to the assessment,
of high stress. They are trained as a psychiatrist, psychiatry registrar
diagnosis, prevention, reduction, and rehabilitation of mental distress,
disability, dysfunctional behaviour, and to improve mental and
(medical doctor doing specialist training to be a psychiatrist), medical
doctor, psychologist, social worker, occupational therapist or nurse.
Case manager – The health care provider whom you see the most
Social worker – A person with specialised training in individual and
for your mental health care in the public mental health system. They
community work, group therapies, family and case work, advocacy
coordinate all your care with other members of the team. They can be
and the social consequences of disadvantage and disability, including
medical doctors, or allied health specialists such as psychologists, social
mental disorders. They can provide psychosocial treatments for
workers, occupational therapists or trained mental health nurses.
mental disorders and assist with welfare needs such as finance or
General practitioner (GP)/ Local doctor/ Family doctor –
Registered medical practitioner, who has a general training in all areas
of medicine, including psychiatry, and manages your general
Occupational therapist (OT) – A person trained to provide therapy
through creative or functional activities that promote recovery and
Sources of information and support
Pharmacist – A person licensed to sell or dispense prescription
For further information on this guideline and other Clinical Practice
Guidelines see www.ranzcp.org.
Psychiatric nurse – A person specially trained to provide promotion,
The list of organisations and information sources provided in this
maintenance, and restoration of mental health, including crisis and
Appendix, whilst not exhaustive, may further support you in learning
case management. Nurses can administer medications but cannot
about and managing schizophrenia. Inclusion of these organisations
prescribe them, whereas other allied health professionals can neither
and information sources does not imply RANZCP endorsement
prescribe nor administer medications.
but rather aims to help people find information and to encourage
communication about mental illness.
These organisations and resources are not intended as a replacement
for formal treatment but as an adjunct to it. If you are unsure about
Phone: (03) 9810 6100
any of the information you find or would like to know if a treatment
you read about may be appropriate for you, you should speak with
Multicultural Mental Health Australia
your mental health care professional.
Phone: (02) 9840 3333
Many of the organisations listed below are community-managed
Email: [email protected]
non-profit associations. They provide mutual support, information,
housing, rehabilitation, employment or advocacy services to people
Australian Institute for Suicide Research & Prevention
with or having had schizophrenia, their relatives and friends.
Phone: (07) 3875 3382
National Ethnic Disability Alliance (NEDA)
Phone: (02) 9687 8933
Mental Illness Fellowship of Australia
Torture and Trauma
Phone: (03) 8486 4200
Phone: (03) 9388 0022
Helpline: (03) 8486 4222
Mental Illness Fellowship of South Australia
Phone: (08) 8221 5160
Phone: (03) 9682 5933
Email: [email protected]
Helpline: 1800 187263
Helpline Email: [email protected]
Multicultural Advocacy and Liaison Services of SA
Email: [email protected]
Phone: (08) 8227 2066
Phone: (02) 6122 9900
Mental Illness Fellowship of Western Australia
Phone: (08) 9228 0200
Email: [email protected]
Phone: (03) 9455 7900
WA Transcultural Mental Health Centre
Phone: (08) 9224 1761
Ethnic Disability Advocacy Centre
Phone: (08) 9388 7455
Mental Illness Fellowship of North Queensland Inc
Mental Illness Fellowship of ACT Inc
Phone: (07) 4725 3664
Phone: (02) 6205 1349
Mental Illness Fellowship of Queensland
ACT Transcultural Mental Health Network
Brisbane: Phone: (07) 3358 4424
Phone: (02) 6207 6279
Email: [email protected]
ACT Multicultural Council
Gold Coast: Phone: (07) 5591 6490
Phone: (02) 6249 8994
NEW SOUTH WALES
Schizophrenia Fellowship of NSW
QLD Transcultural Mental Health Centre
Phone: (02) 9879 2600
Phone: (07) 3167 8333
Advocacy for NESB People with a Disability (AMPRO)
Phone: (07) 3369 2500
NSW Transcultural Mental Health Centre
Phone: (02) 9840 3800
Mental Illness Fellowship of Victoria
NSW Multicultural Disability Advocacy Association
Phone: (03) 8486 4200
Phone: (02) 9891 6400
Helpline: (03) 8486 4265
Mental Health Carers NT
Phone: (08) 8948 2473
Victorian Transcultural Psychiatry Unit (VTPU)
Phone: (03) 9288 3300
Top End Mental Health Service
Action on Disability within Ethnic Communities (ADEC)
Phone: (08) 8999 4988
Phone: (03) 9480 1666
Multicultural Community Services of Central Australia
Victorian Mental Illness Awareness Council
Phone: (08) 8952 8776
Phone: (03) 9387 8317
Email: [email protected]
Associations for the Relatives and Friends
ARAFMI Tasmania (Carer support)
of the Mentally Ill (ARAFMI)
Phone (North): (03) 6331 4486
Phone (South): (03) 6228 7448
Email (North): [email protected]
Phone: (08) 9427 7100
Email (South): [email protected]
ARAFMI New South Wales
Phone: (03) 9810 9300
Central Coast ARAFMI: (02) 4369 4233
Carer Helpline: 1300 550 265
ARAFMI Illawarra: (02) 4254 1699
Victorian Mental Health Carers Network
Phone: (03) 8803 5555
ARAFMI Hunter: (02) 4961 6717
ARAFMI North Ryde : (02) 4961 6717
Support: 1800 655 198 (NSW rural); (02) 9332 0700 (Sydney)
Provides a range of links
Phone: (07) 3254 1881
to and information on
government initiatives and
programs, as well as general information on mental
ARAFMI Western Australia
Perth: (08) 9427 7100
Facilitates access to state-
Rural Freecall: 1800 811 747
based support for family
Hillarys: (08) 9427 7100
Midland: (08) 9347 5741
Information and program
Mandurah: (08) 9535 5844
on early psychosis; includes
Broome: (08) 9194 2665
factsheets on psychosis and
Canarvon: (08) 9941 2803
related topics (also available in languages other than English).
Youth information portal on mental health.
Information and advice
Anti-psychotic medication – A group of medications used to treat
regarding mental health problems and where young
people can find help and
Delusion – A symptom of psychosis. A delusion is an illogical belief
that is held strongly, even in the face of evidence that it is false.
Information on mental health
Depression – A mood disorder ranging from passing sad moods
including factsheets; also includes an online helpline.
to a serious disabling illness requiring medical and psychological
treatment. Major depression is a ‘whole body' disorder, which impacts
Website for young
on the patient's emotions (feelings of guilt and hopelessness or loss
people dealing with mental illness in their family.
of pleasure in once enjoyed activities), thinking (persistent thoughts
of death or suicide, difficulty concentrating or making decisions),
Information on mental
behaviour (changes in sleep patterns, appetite or weight), and
illness for consumers, carers,
clinicians and the general
even physical wellbeing (persistent symptoms such as headaches or
public. Includes factsheets
digestive disorders that do not respond to treatment).
and other resources.
Hallucination – A false or distorted perception of objects or events,
including sensations of sight, sound, taste, touch and smell, typically
with a powerful sense of their reality.
Mental illness – A general term for a wide range of disorders of the
brain involving both psychological and behavioural symptoms.
Mental disorder – A mental illness such as ‘schizophrenia' which is
diagnosable under agreed international criteria.
Negative symptoms – Symptoms where a normal behaviour or
emotion, such as motivation, socialisation, or interest is lacking. They
are called negative symptoms because the behaviour or emotion has
been removed from the normal range of behaviours.
Neuroleptics – Another name for anti-psychotic medication.
Paranoia – An insidiously developing pattern of unfounded thoughts
and fears, often based on misinterpretation of actual events. People
with paranoia may consider themselves endowed with unique and
superior abilities or may have the delusion that others are conspiring to
Development of the guideline
do them harm.
This guide is a research-based clinical practice guideline based on a thorough
Positive symptoms – Symptoms such as delusions, hallucinations,
review of the medical and related literature. It was written in association
disorganised thinking and agitation (called positive because the
with people who have schizophrenia and those working with them.
behaviour adds to what is considered normal).
In 2009, the content of this guide was revised and expanded by an expert
Prodrome – Low-grade symptoms and a period of change in behaviour
advisory panel comprising mental health professionals, and consumer
experienced before an episode of psychosis.
and carer representatives. The purpose of the revision was to ensure the
Psychosis – This is central to a group of mental disorders that
information contained in the booklet was current and comprehensive in
include loss of contact with reality e.g. hallucinations or delusions
terms of treatment best-practice and therefore remained relevant for people
and breakdown of normal social functioning and extreme personality
with schizophrenia and their carers, families, and friends.
changes. A psychotic episode may be short lived or chronic.
Psychotherapy/Psychological intervention – A form of treatment
for mental disorders based primarily on verbal communication between
The authors of the original edition, and their affiliations at the time, were:
the patient and a mental health professional, often combined with
Eoin Killackey – Clinical Psychologist and Research Fellow, Orygen
prescribed medications. Psychotherapy can be conducted in individual
sessions or in a group.
Patrick McGorry – Professor of Psychiatry and Director, Orygen
Symptom – A feeling or specific sign of discomfort or indication
Kathryn Elkins – Clinical Psychologist, Orygen Research Centre
representing the Australian and New Zealand Clinical Practice Guidelines
Team for Schizophrenia.
Crisis Assessment Team
The Australian and New Zealand Clinical Practice Guidelines Team for
Cognitive Behavioural Therapy
Schizophrenia was chaired by Professor Patrick McGorry, Professor of
Psychiatry, University of Melbourne.
Magnetic Resonance Imaging
The expert advisory panel for the 2009 revision comprised:
Professor Patrick McGorry – (Chair) Professor of Psychiatry and Director,
Orygen Research Centre
Mr Evan Bichara – Consumer Advocate, Victorian Transcultural
Psychiatry Unit, St Vincent's Hospital, Melbourne
Dr Eoin Killackey – Ronald Philip Griffith Fellow, Senior Research Fellow
& Clinical Psychologist, Orygen Research Centre
Dr Margarett Leggatt – AM PhD BAppSc (OT) Consultant in Mental
Health Family Work
The original edition of this guide was consulted upon bi-nationally and
drafts were available for comment on www.ranzcp.org. It was appraised
using DISCERN by a national workshop of consumer consultants and
meets NHMRC criteria for presenting information on treatments for
consumers. The revision process sought to maintain the integrity of this
process by incorporating updated information supported by research
findings published in recent medical and other scientific literature.
The project to develop and print the original version of this booklet
was commissioned by the Royal Australian and New Zealand College
of Psychiatrists and was funded by Australia's National Mental Health
Strategy, Commonwealth Department of Health and Ageing, and the
New Zealand Ministry of Health.
The RANZCP drew on material published by the Medical Practitioner's
Board of Victoria and the American Psychiatric Association in preparing
The RANZCP also acknowledges the input of Professor Kulkarni of The
Alfred Psychiatry Research Centre, Melbourne.
The 2009 revision and reprint was undertaken with funding provided by
the Commonwealth Department of Health and Ageing.
Collaborative working environments for enterprise incubation – The Sekhukhune Rural Living Lab Christian MERZ1, Rudi DE LOUW2, Nina ULLRICH1 1SAP Research, CEC Karlsruhe, Vincenz-Priessnitz-Strasse 1, Karlsruhe, 76131, Germany Tel: +49 721 69020, Fax: +49 721 696816, Email: 2SAP Research, CEC Pretoria, Persequor TechnoPark, Pro Park Building 3, 29 de
eCAM Advance Access published February 2, 2009 eCAM 2009;Page 1 of 8 Acupuncture and Auricular Acupressure in RelievingMenopausal Hot Flashes of Bilaterally OvariectomizedChinese Women: A Randomized Controlled Trial Jue Zhou1,*, Fan Qu2,*, Xisheng Sang3, Xiaotong Wang4 and Rui Nan5 1Sino-Britain Joint Laboratory, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, Zhejiang310058, 2Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310006, 3HeilongjiangUniversity of Chinese Medicine, Harbin, Heilongjiang, 150040, 4The First Affiliated Hospital, Liaoning University ofChinese Medicine, Shenyang, Liaoning, 110032, P. R. China and 5Colorado School of Traditional ChineseMedicine, 1441, York Street, Denver, CO 80206, USA