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Psychopharmacology Algorithms: Schizophrenia David N. Osser, MD, Associate Professor of Psychiatry Harvard Medical School Brockton Division of the VA Boston Healthcare System General Editor - Psychopharmacology Algorithm Project Harvard South Shore Residency Training Program

More complicated situations Treatment resistance Patients never previously treated with an antipsychotic (first onset)

More complicated situations Treatment resistance Patients never treated with an antipsychotic (first onset) Practical strategies

Importance of effectiveness Equally important: long-term side effects

Greater emphasis on milder side effects profile First Trial Greater emphasis on milder side effects profile

Greater emphasis on efficacy First Trial Second Trial Greater emphasis on efficacy Greater emphasis on milder side effects profile Toxicity awareness

Recommendations based on knowledge of the evidence base Clinical experience is considered in decision making He/she gives a recommendation or asks more questions When the evidence is limited: conservative and flexible approaches Questions to a psychopharmacology consultant

Recommendations based on knowledge of the evidence base Clinical experience is considered in decision making He/she gives a recommendation or asks more questions When the evidence is limited: conservative and flexible approaches Questions to a psychopharmacology consultant

Recommendations based on knowledge of the evidence base Clinical experience is considered in decision making He/she asks more questions or gives a recommendation When the evidence is limited: conservative and flexible approaches Questions to a psychopharmacology consultant

Recommendations based on knowledge of the evidence base Clinical experience is considered in decision making He/she asks more questions or gives a recommendation When the evidence is limited: conservative and flexible approaches Questions to a psychopharmacology consultant

Clinician user of this algorithm Willingness to be guided by the evidence Awareness of the complexity of cases Recognition of perils of unsystematic approaches Clinician user of this algorithm

Unique characteristics of each case Decision making in EBM Clinician experience Patient preferences Unique characteristics of each case

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