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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 Website: www.ranzcp.org Appendix 5: Common terms and acronyms Appendix 6: Development of the guideline Acknowledgements 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: Negative symptoms
Feeling unmotivated Most people experience changes in behaviour and perception. When Not feeling social Suicidal thoughts these occur together in the early stages they are called a ‘prodrome'. Feeling apathetic 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 Disorganised symptoms
hearing sounds not heard by others.
Difficulty making decisions The prodromal period lasts approximately two years on average. Difficulty planning 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 nervous system.
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 schizophrenia face? 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 good recovery.
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 services required.
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 treatment plan.
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 another medication.
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. treatment order.
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 mind restoring.
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 your recovery.
good results when other treatments are not successful. However, if you are taking clozapine you will need to be closely monitored for side effects.
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 Family psychoeducation 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, Prahran, Melbourne.
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 with schizophrenia.
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 community agencies.
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 positive activity.
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 in hospital.
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 in hospital.
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 hinder recovery. 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 don't understand.
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. SCENARIO
A Excess medication
Inform nurse or doctor of side effects. Dosage D Negative attitudes
may be reduced, medication changed to a to schizophrenia? 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 B Traumatic
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 hospital staff.
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 ii. Subsequent
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 iii. Declining
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.
Medication guide 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 Anticholi- Extra- Range (mg) Sedation Cholinergic pyramidal Gain Range (mg)4 (weeks) Sedation Cholinergic pyramidal Gain Newer agents
IC Amisulpride 100-1000 + + 0 ++2 + Fluphenazine 12.5-50 ++(initial y) +++(initial y) 0 ++(initial y) +++(initial y) 0 Zuclopenthixol 200-4005 Older agents
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 health care.
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, Website: www.mmha.org.au 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 Website: www.mifsa.org Helpline Email: [email protected] Multicultural Advocacy and Liaison Services of SA
Email: [email protected] Phone: (08) 8227 2066 Website: www.sane.org 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
Website: www.sfa.org.au 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) Web address
Website: www.arafmi.org 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). Web address
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.
General Practitioner Magnetic Resonance Imaging The expert advisory panel for the 2009 revision comprised: Occupational Therapist Professor Patrick McGorry – (Chair) Professor of Psychiatry and Director,
Tardive Dyskinesia 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 Quality statement 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 this booklet.
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.
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