Management of psychosis and schizophrenia in adults: summary of updated NICE guidance

Abstract

Psychosis is relatively common, with schizophrenia being the most prevalent form of psychotic disorder, affecting about seven in 1000 adults, with onset typically occurring between the ages of 15 and 35.1 These disorders, which are characterised by distressing hallucinations and delusions, disturbed behaviour, and memory and motivation problems, present a major personal,2 social,3 clinical,4 and financial5 challenge. Moreover, poor physical health is strongly associated with schizophrenia, with men dying 20 years earlier than the general population and women dying 15 years earlier,6 7 mainly from illnesses such as cardiovascular disease, diabetes, chronic obstructive pulmonary disease, HIV infection, hepatitis C, and tuberculosis.8 Difficulties in people with severe mental illness accessing general medical services in primary and secondary care contribute to reduced life expectancy.9 Although many people with psychosis and schizophrenia respond to antipsychotic drugs initially, around 80% relapse within five years, partly because they discontinue medication,10 which for many people has unacceptable side effects. However, although around 75% of people with schizophrenia recurrently relapse and have continued disability,10 there is a moderately good long term global outcome in over half.11 This article summarises the most recent recommendations from the National Institute for Health and Care Excellence (NICE) on managing psychosis and schizophrenia in adults.12 NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets. ### Care across all phases—physical health