NEWS RELEASE March 27, 1997
AMERICAN PSYCHIATRICASSOCIATION 1400 K Street, N.W., Washington, DC 20005
Media: See separate sheet on "How to Interview the Experts on the April 1, 1997, Release of the American Psychiatric Association's Guideline for the Treatment of Patients With Schizophrenia" Note: For those media who do not yet have the full Schizophrenia guideline backgrounder kit, the sheet on how to interview the experts (who will be available by phone on Friday 3/28 and Monday 3/31) is available through APAFastFAX (our toll-free fax-on-demand service). Call 1+888-267-5400 and select document No. 6901.
CONTACT: Gus Cervini; (202) 682-6142; [email protected]
EMBARGOED UNTIL APRIL 1, 1997
APA PUBLISHES FIRST PRACTICE GUIDELINE FOR THE TREATMENT OF ADULT PATIENTS WITH SCHIZOPHRENIA
The American Psychiatric Association has published the first comprehensive guideline for the treatment of adult patients with schizophrenia, the seventh in the APA series of practice guidelines for mental illnesses and substance use disorders. The Practice Guideline for the Treatment of Patients With Schizophrenia, based on the latest research findings, stresses the value of new medications in the treatment of the disorder, and recommends a range of psychiatric and rehabilitative approaches. The guideline emphasizes the importance of early diagnosis and treatment and the need for comprehensive and continuous long-term psychiatric treatment.
The guideline, published in the April American Journal of Psychiatry, is the work of a six-member work group led by Marvin I. Herz, M.D. Over 91 individuals and more than 15 professional and consumer organizations reviewed and commented on the guideline. The guideline was developed by psychiatrists who are involved in research as well as clinical practice. Among the organizations which reviewed the guideline is the National Alliance for the Mentally Ill. The guideline was approved for publication by APA's Board of Trustees in December 1996.
The scientific evidence-based Schizophrenia guideline is designed to help psychiatrists tailor treatment for individual patients. The guideline indicates the extent of scientific evidence available to support the effectiveness of each type of treatment. Treatments are recommended with "substantial clinical confidence," with "moderate clinical confidence," or "on the basis of individual circumstances." The guideline discusses the use of conventional antipsychotic medications (e.g., haloperidol), as well as newer antipsychotics (e.g., clozapine, risperidone, olanzapine). Sertindole and quetiapine, which are not yet approved by the FDA, also are covered.
The guideline notes that the newer antipsychotic medications (olanzapine, sertindole, quetiapine) were developed in part with the goal of reducing the side effects that are common with conventional antipsychotics. Clozapine, a highly effective antipsychotic for many patients who have not responded to other medications, can cause potentially fatal agranulocytosis in about 1 percent of patients. (Agranulocytosis is a reduction in the number of white blood cells which fight infection.)
The three newer medications appear to avoid this side effect and also appear to reduce or eliminate others such as muscular rigidity, tremors, shuffling gait, restlessness, peculiar involuntary postures, and slowed movement. In the past, many patients with schizophrenia have refused to take their medications as a result of such side effects.
VIEWPOINTS OF THE EXPERTS
Deborah A. Zarin, M.D., Director of APA's Practice Guideline Program and a member of the APA Steering Committee on Practice Guidelines, on the purpose of APA's practice guidelines:
"The practice guideline shouldn't be interpreted as a standard of medical care, but must be considered only as a guideline. The ultimate judgment regarding a treatment plan must be made by the psychiatrist on the basis of the clinical data presented by the patient and the diagnostic and treatment options available in the particular clinical setting."
John S. McIntyre, M.D., chair of the APA Steering Committee on Practice Guidelines, on the guideline development process and the value of practice guidelines:
"The development process for this guideline, coordinated by the APA Steering Committee on Practice Guidelines, involved a comprehensive literature review and the production of several drafts, each of which received widespread review. Like the APA's other guidelines, the Practice Guideline for the Treatment of Patients With Schizophrenia will be reviewed and updated at three- to five-year intervals. The guideline provides for clinicians evidence-based suggestions about practice in the treatment of patients with schizophrenia. There are significant treatments for this illness that are clearly effective. Many of the decisions about treatment and about reimbursement currently are being made in the absence of scientific data and professional input. Practice guidelines are a way to provide that type of scientific and professional input for these decisions.
The practice guidelines' strength lies in their presentations of the full spectrum of treatments and treatment perspectives -- a breadth of treatment choices that demonstrates the illnesses' complexity and the care needed in treating patients with these illnesses. Our practice guidelines are part of a movement within organized medicine to create treatment guidelines for doctors in all the major specialities.
The Schizophrenia guideline will help psychiatrists through a clear, concise, and medically sound presentation of the range and quality of available psychiatric treatments for the illness. Psychiatrists still bear the ultimate responsibility for choosing the best treatment strategy for each patient."
Marvin I. Herz, M.D., Chair of the APA's Work Group on Schizophrenia, on new medications, early treatment, and ongoing support:
"The recent revolution in the treatment of schizophrenia began with the introduction of clozapine. The advent of the newer antipsychotic medications offers the psychiatrist new tools for the management of this disorder, and offers patients new hope for improved treatment. Prompt diagnosis and treatment remain key to better treatment outcomes, as does the availability of comprehensive and continuous care in the community."
Constance E. Lieber, President of the National Alliance for Research on Schizophrenia and Depression (NARSAD), on the importance of schizophrenia research:
"Recent discoveries in neuroscience and new technologies in brain research have allowed more progress in the treatment of severe psychiatric diseases, such as schizophrenia, than had been achieved in the entire history of humankind. As our understanding of the structure and functions of the brain has become clearer, psychiatrists and other physicians are being offered a whole new array of pharmacological weapons to help in the treatment of both the positive and negative symptoms of schizophrenia. The practice guideline developed by the APA will help psychiatrists explore the treatment options available and choose a treatment plan that will most benefit each patient."
Laurie M. Flynn, Executive Director of the National Alliance for the Mentally Ill (NAMI) on the guideline, insurance coverage, and public health care:
"NAMI hails the practice guideline as a significant step toward improving the treatment of patients with schizophrenia. However, discriminatory health insurance coverage for mental illnesses, and inadequate support to the nation's public mental health systems will continue to deny many of these most vulnerable individuals access to the very treatments recommended in the guideline as most effective. Society pays a high price when people with schizophrenia are denied treatment, necessary public assistance, and supportive housing. We must continue our battle against these inequities."
FACTS ABOUT SCHIZOPHRENIA (from the guideline)
About 1 percent of Americans will develop schizophrenia. Two million individuals currently have the disorder. The risk of developing schizophrenia is increased if a relative has the illness -- especially a parent, brother, or sister -- and if more than one relative is affected. Considered a brain disease, schizophrenia's effects vary from person to person. It can cause distorted thinking, delusions, and hallucinations, and it dulls normal emotions. It is one of the most debilitating and misunderstood illnesses known. Unfortunately, it is a chronic illness that affects most sufferers over a lifetime. However, its symptoms generally can be controlled with treatment.
The symptoms of schizophrenia often are described as falling into two categories -- positive (including delusions and hallucinations, which are highly responsive to treatment) and negative (including flattened emotions and reduced thought and speech). The new guideline notes the importance of acknowledging a third category -- disorganized symptoms (including disorganized thought, speech, and behavior, and poor attention). Patients with primarily disorganized symptoms tend to be the most severely affected by schizophrenia and their illness the most difficult to treat, while patients with paranoid symptoms tend to be the least severely affected.
Some patients with schizophrenia have other psychiatric illnesses, non-psychiatric medical conditions and substance use disorders, especially alcohol dependence. Such comorbid conditions can worsen the course of the illness and complicate treatment.
Schizophrenia, especially when left untreated or undertreated, has devastating effects on patients, families and their communities. Early diagnosis and treatment can help reduce the likelihood of relapse and repeat hospitalization. Studies show that patients who go untreated for a long time following their first psychotic episode have poorer responses to treatment and poorer long-term outcomes. Schizophrenia is associated with homelessness and incarceration. Patients with the disorder comprise approximately ten percent of America's totally and permanently disabled population. Premature death, especially from suicide, occurs in up to ten percent of patients with this illness.
Important note to media viewing this release online or via APAFastFAX:
In addition to this release, the APA offers to media a backgrounder kit on the new practice guideline. The kit includes:
--the guideline itself
--a separate sheet on "How to Interview the Experts on the April 1, 1997, Release of the American Psychiatric Association's Guideline for the Treatment of Patients With Schizophrenia" -- Note: For those media who do not yet have the full backgrounder kit, the sheet on "How to Interview the Experts" is available through APAFastFAX (APA's toll-free fax-on-demand service). Call 1+888-267-5400 and select document No. 6901. Experts will be available for interviews on Friday 3/28 and Monday 3/31 (the day before the guideline's release).
--backgrounder on the APA practice guideline development process
--reprint of an American Journal of Psychiatry editorial on APA's practice guidelines
--photocopy of the section on schizophrenia from the APA's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV).
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APA Practice Guidelines -- as of Spring 1997
Guideline/Published:
Eating Disorders/February 1993 Major Depressive Disorder/April 1993 Bipolar Disorder/December 1994
Substance Use Disorders/November 1995
Psychiatric Evaluation/November 1995
Nicotine Dependence/October 1996
Schizophrenia/April 1997
Alzheimer's Disease and Related Dementias/Forthcoming: May 1, 1997
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Media, please note: The Practice Guideline for the Treatment of Patients With Schizophrenia is embargoed until 4/1/97. Journalists may obtain free copies of the new practice guideline and be put in contact with national and local psychiatric media speakers who are experts on the treatment of patients with schizophrenia. Please contact Gus Cervini, APA Media Coordinator, at (202) 682-6142 (voice), e-mail: [email protected], or (202) 682-6255 (fax).
Journalists should refer the public (non-media) to the American Psychiatric Press, Inc. (APPI), 1+(800) 368-5777, from which the guideline may be purchased for $22.5O, APPI Order No. 2309.
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This release and other APA materials for media are available in electronic format. On the World Wide Web, visit the SciNews-MedNews library of Newswise at http://ari.net/newswise. On APA's website, go to http://www.psych.org, and look in the "News Stand" area. CompuServe subscribers can visit CompuServe's Journalism Forum (go jforum), look in the SciNews-MedNews Library (library 17), and select files ending in the extension ".apa" (e.g., "schizrel.apa"). If you wish to obtain a copy of this release by fax, it is available through APAFastFAX (APA's toll-free fax-on-demand service). Call 1+888-267-5400 and select document No. 6120. Other recent APA media releases also are available through APAFastFAX. Dial the toll-free number, and request a copy of the APAFastFAX menu when prompted. After you have received the menu by fax, look under the heading "Public Information," and select the particular release(s) you wish to have faxed to you.
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The American Psychiatric Association is a national medical specialty society, founded in 1844, whose 42,000 physician members specialize in the diagnosis and treatment of mental and emotional illnesses and substance use disorders.
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