We Should Improve Personalization of Management in Patients with a Diagnosis of Schizophrenia.

Alfonso Tortorella

doi:10.3390/jcm11010184

Abstract

The current management of patients with schizophrenia is marked by a lack of personalization. After the diagnosis is made, a second-generation antipsychotic is usually prescribed based on the current clinician’s preferences, sometimes accompanied by a psychosocial intervention which is typically not evidence-based and not targeted to the specific needs of the individual patient. In this opinion paper, some steps are outlined that could be taken in order to address this lack of personalization. A special emphasis is laid on the clinical characterization of the patient who has received a diagnosis of schizophrenia. Considerations are put forward concerning the assessment of the negative dimension in ordinary clinical practice, which is often neglected; the evaluation of cognitive functioning using a simple test battery which requires limited professional training and takes no more than 15 min to administer; the evaluation of social functioning using a validated instrument focusing on personal care skills, interpersonal relationships, social acceptability, activities, and work skills; and the assessment of the unmet needs of the person (including practical, social, and emotional needs, and existential or personal recovery). The implications of the assessment of these domains for the formulation of the management plan are discussed.

Highlights

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations
After a diagnosis of schizophrenia is made, often without referring to formal diagnostic systems [1,2], the management is often stereotyped, with the prescription of a secondgeneration antipsychotic based on the current preferences of the clinician [3] and sometimes the addition of a psychosocial intervention which may not be evidence-based and not targeted to the specific needs of the individual patient [4]
The paper is intended for clinicians worldwide, it is understood that there are several contexts in which significant advances have been already made in the personalization of management of patients with schizophrenia, e.g., [8], and others in which the available resources will allow the implementation of only part of the steps indicated

Summary

Introduction

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. After a diagnosis of schizophrenia is made, often without referring to formal diagnostic systems [1,2], the management is often stereotyped, with the prescription of a secondgeneration antipsychotic based on the current preferences of the clinician [3] and sometimes the addition of a psychosocial intervention which may not be evidence-based and not targeted to the specific needs of the individual patient [4].

Results

Conclusion