Patient discussions

Education about the illness and medication is important for all patients, so that they understand their condition and to improve medication adherence.[212] Unfortunately there is a current lack of evidence-based guidance on communicating a diagnosis of schizophrenia initially.[213] Factors to discuss include prognosis and treatment options; this can be challenging given that these may vary substantially between patients, and also because the patient may be acutely ill. It is vital that patients consistently take their medication. Any changes should be under the supervision of a specialist. Stopping medication abruptly can be dangerous as the symptoms are likely to return, which can result in functional decline and danger to self and others. Gradual, monitored reduction of antipsychotic medication over a period of months is also more likely to lead to relapse than continuing on maintenance treatment, and does not improve social functioning.[214] Patients should be advised that maintenance on antipsychotic drugs prevents relapse. In a Cochrane analysis of 75 randomised controlled trials, the chance of relapse at 7-12 months was 24% with antipsychotic treatment compared with 61% with placebo.[125]​ This effect must be weighed against the adverse effects of antipsychotic drugs.[125]​ If the patient experiences uncomfortable adverse effects, these issues should be discussed with their physician and appropriate medication adjustments made.

Ensure patients, carers, and key-workers are aware of the early signs of relapse and how to access help.​[133] Identify and aim to modify risk factors that increase the chance of relapse. These are:[68][133][134] 

  • Poor adherence to medication[135]

  • Presence of persistent psychotic symptoms[133] 

  • Lack of insight

  • Substance misuse.[136] 

Address alcohol and substance misuse and encourage smoking cessation.[1][87]​​

  • Smoking is a major contributor to increased mortality in individuals with serious mental illness.[9]​[127]​[128]​

  • People with schizophrenia are more likely to smoke than the general population but are less likely to be offered support to quit.[87][129] 

Physical activity should be recommended to improve symptoms, cognition, and quality of life.[215]​

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