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While some guidelines exist for the treatment of schizophrenia, they are often country-specific. The new International Guidelines for Algorithmic Treatment (INTEGRATE), published in the Lancet, provide a structured sequence of actions and criteria designed to guide clinicians through the diagnostic, treatment, and management processes for schizophrenia.
Lead author Associate Professor Rob McCutcheon said the aim is for clinicians to adopt the guidelines in practice, with ambitions that they also inform national guidelines.
Schizophrenia affects approximately 0.7% of the global population during their lifetime, and is a significant health-care burden worldwide. Although effective treatments exist, pharmacological treatments often have substantial side-effects, like weight gain, diabetes, and movement problems, and delays in providing the best treatment are common.
Experts from 30 countries came together from all regions of the United Nations to develop the guidelines, and included co-authors Professor Belinda Lennox, Dr Ioana Varvari and Dr Thomas Kabir from the Department of Psychiatry and senior author Professor Dan Siskind at the University of Queensland. They conducted an umbrella review of the literature, expert workshops, a consensus survey, and lived experience focus groups to develop the guidelines, which are designed to be used anywhere in the world.
Key recommendations include a focus on metabolic health from the beginning of treatment, mitigation of side-effects, and the prompt use of clozapine in cases of treatment resistance.
Alongside the guidelines, researchers also developed a digital tool where users can input their symptoms, medications, and side-effects, and the software presents them with the relevant guidelines.
The authors have answered key questions about the guidelines below.
How will these new international guidelines make a difference to people living with schizophrenia?
The new INTEGRATE guidelines offer a practical, step-by-step approach to choosing and managing medications for people with schizophrenia. Unlike older guidelines that were often too long or focused only on specific countries, these are designed to be used anywhere in the world. They help doctors and people with schizophrenia act faster when treatment isn’t working, focus on each person’s symptoms, and manage side effects early. This means people can get the right treatment sooner, feel better faster, and reduce the risk of serious physical health problems that often go along with schizophrenia.
What are the harmful side effects associated with medications to treat schizophrenia?
Medications for schizophrenia, especially antipsychotics, can cause a range of side effects. These may include weight gain, diabetes, high cholesterol, movement problems like tremors or restlessness, hormonal changes such as raised prolactin, and sleepiness. Some side effects can increase the risk of serious health issues like heart disease or diabetes, so regular monitoring and early management are very important.
Do these side effects have a significant impact on whether people continue to take their medications?
Yes, side effects are one of the main reasons people stop taking their medication. If someone feels worse on the medication or gains a lot of weight quickly, they may choose to stop taking it, even if it's helping their mental health symptoms. That’s why these guidelines stress shared decision-making and early action to manage side effects—so people are more likely to choose to stick with treatment.
Are there new treatments that will potentially improve the lives of people with schizophrenia?
Yes, there are promising new treatments on the horizon. For example, GLP-1 receptor agonists, a type of medication also used for diabetes and weight loss, may help manage weight gain caused by antipsychotics. A new medicine called xanomeline-trospium has also been approved and works differently from traditional antipsychotics, which could offer benefits for people who haven’t responded well to existing medications. Researchers are also working on tools to predict which treatments might work best for each individual.
What is your message to those living with schizophrenia or their loved ones, and to their doctors with the release of these guidelines?
These new guidelines offer hope. They show that treatment can be tailored to the individual, with careful attention to both mental and physical health. For people living with schizophrenia and their families, it’s a reminder that their voice matters in treatment decisions. For doctors, it’s a call to act early, listen closely, and work together with patients. Better treatment is not just about controlling symptoms—it’s about improving quality of life.