Schizoaffective disorder

Patient education about their diagnosis, medication, and self-management fosters insight, adherence, and improved health-related quality of life.[61]Katschnig H. Rehabilitation in schizophrenia; guidelines for including psychosocial measures [in German]. Wien Med Wochenschr. 1998;148(11-12):273-80. http://www.ncbi.nlm.nih.gov/pubmed/9746970?tool=bestpractice.com [101]Cimo A, Stergiopoulos E, Cheng C, et al. Effective lifestyle interventions to improve type II diabetes self-management for those with schizophrenia or schizoaffective disorder: a systematic review. BMC Psychiatry. 2012 Mar 23;12:24. http://www.biomedcentral.com/1471-244X/12/24 http://www.ncbi.nlm.nih.gov/pubmed/22443212?tool=bestpractice.com

Any medication changes should be done under the supervision of a physician. Patients who experience adverse effects should discuss the issues with their physician and appropriate alterations should be made. Stopping medication abruptly can be dangerous because the symptoms are likely to return, which can result in disability and danger to self and others. Patients who begin to experience command auditory hallucinations, suicidal thoughts, thoughts of harming others, or other severe symptoms should be instructed to call their doctor, call the emergency call number, or go to the nearest emergency department. Additionally, drugs and alcohol should be avoided, because these substances can worsen symptoms, cause symptoms to reappear, and increase drowsiness and sedation.

Peer-led advocacy groups can be helpful for patients and their families by providing practical and emotional support, as well as being sources of information about the condition itself, available resources (e.g., groups, volunteering opportunities, job training, and employment), economic and legal matters, and other information.

For females of childbearing age, valproate treatment should not be started unless alternative treatments are not suitable; females of childbearing age must follow a pregnancy prevention programme while on treatment with valproate medicines. For EU countries, the European Medicines Agency states that this programme should include:[52]European Medicines Agency. New measures to avoid valproate exposure in pregnancy endorsed. 23 March 2018 [internet publication]. https://www.ema.europa.eu/en/documents/referral/valproate-article-31-referral-new-measures-avoid-valproate-exposure-pregnancy-endorsed_en.pdf

• An assessment of patient’s potential for becoming pregnant

• Pregnancy tests before starting and during treatment as needed

• Counselling about the risks of valproate treatment and the need for effective contraception throughout treatment

• A review of ongoing treatment by a specialist at least annually

• A risk acknowledgement form that patients and prescribers will go through at each such annual review to confirm that appropriate advice has been given and understood.