Guidelines for first-episode schizophrenia pharmacological treatment reviewed

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  • The National Institute for Health and Care Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN), and Spanish guidelines fared best, and there is overall agreement that clozapine (Clozaril, FazaClo ODT, Versacloz) is the first choice for treatment-resistance.

Why this matters

  • About 75% of individuals with schizophrenia will experience a relapse after the first episode. The study is the first to look at the quality of guidelines for treatment of first-episode schizophrenia.

Study design

  • The researchers used the Appraisal of Guidelines for Research and Evaluation II instrument to analyze 10 guidelines.
  • Funding: The study received no funding.

Key results

  • All guidelines cited clozapine as the treatment of choice for treatment resistance.
  • 3 guidelines performed best across all domains: NICE, SIGN, and the Spanish guidelines.
  • A major focus of the guidelines was the side effect profile of medicines, rather than comparative efficacy.


  • There is little evidence available as to how to treat patients who do not respond to clozapine.
  • Many of the included guidelines are more than 5 y old.