Time to 'get real': preliminary insights into the long-term management of schizophrenia

Objective: A brief file and medication chart review was undertaken to examine the 'real world' treatment of schizophrenia, with a particular focus on long-term treatment strategies that extend beyond existing evidence-based guidelines. Method: Treatment strategies were identified through an audit of patient files and their medication charts for patients admitted 25 years in a non-acute psychiatric hospital. Results: Twenty-nine file reviews and 20 medication chart audits were conducted. High levels of diagnostic heterogeneity were identified with the presence of psychosis and mood-related diagnoses (primarily schizophrenia and schizoaffective disorder) and high rates of comorbidity (86%). Functional impairment, poor insight and high levels of risk were present in most patients. Treatments largely consisted of combination strategies with 75% of patients prescribed two or more antipsychotics and an average of 3.4 psychotropic medications in total. While clozapine was commonly prescribed (65%), this was often in combination with, on average, two other psychotropic agents. Conclusions: Notwithstanding the limited sample, these findings provide a valuable glimpse into the management strategies employed in the long-term management of schizophrenia. Evidence-based guidelines are largely of limited value for this cohort that often has complex presentations and further research is urgently needed to provide guidance into management strategies that extend beyond 5 years, with particular emphasis on the utility of medication combinations.