• Utilize evidence-based screening tools to identify individuals at risk for psychosis.
• There is no recommendation for or against the use of biomarker screening tools to identify individuals at risk for psychosis.

• Treatment with early intervention services is recommended.
• Family interventions such as education, family support, and problem solving are recommended.
• The use of the Individual Placement and Support model is suggested for patients with a goal of education and/or employment.
• There is no recommendation for or against any specific duration of therapy for early intervention services, nor is there a recommendation for or against a specific duration of treatment with antipsychotic medication after response or remission.

• An antipsychotic medication, other than cloZAPine, is recommended treatment for an acute episode of schizophrenia or first-time psychosis.
• Antipsychotic medication is recommended for maintenance therapy to prevent relapse and hospitalization.
• Trial of another antipsychotic medication is suggested for patients who do not respond to a trial of an antipsychotic medication.
• Long-acting injectable antipsychotics are suggested to improve medication adherence.
• Choice of antipsychotic medications should be based on individual patient evaluation, characteristics, and the side effects of the medications.
• CloZAPine is recommended for patients with treatment-resistant schizophrenia.
  • Augmenting cloZAPine with another second-generation antipsychotic is suggested in patients without adequate response from cloZAPine alone.

• There is no suggestion for or against the treatment of hyperprolactinemia-related side effects of antipsychotic medications.
• MetFORMIN, topiramate, or aripiprazole augmentation is suggested for treatment of metabolic side effects and weight loss.
• A trial of a vesicular monoamine transporter 2 inhibitor is suggested to treat tardive dyskinesia.
• Diphenhydramine is suggested for patients with sialorrhea (excessive salivation).
• There is no recommendation for or against the augmentation with nonantipsychotic medications to treat cognitive or other negative symptoms. 

• To decrease the risk for relapse and hospitalization, the following are recommended:
  • Psychosocial interventions for a support person or family member
  • Use of service models based on standard Assertive Community Treatment for patients showing signs of severe functional impairments.
• Employment support is recommended for patients with schizophrenia, as appropriate.
• Face-to-face individualized smoking cessation intervention is recommended.
• Cognitive training programs to treat impairments are suggested.
• Skills and training for patients with severe functional impairments or deficits in problem-solving, social, and social-cognitive skills is suggested.
• Aerobic exercise and/or yoga are suggested as additions to treatment to reduce symptoms and improve function.
• Cognitive behavioral therapy is suggested in combination with pharmacotherapy in patients with prodromal and early psychosis.
• Dietary interventions, exercise, lifestyle counseling, and/or psychoeducation for metabolic side effects and weight management are suggested.
• There is no recommendation for or against the following:
  • Specific supported housing interventions for patients with housing insecurities
  • Transcranial direct current stimulation and repetitive transcranial magnetic stimulation
  • Electroconvulsive therapy
  • Motivational interviewing or shared decision-making to increase medication compliance
  • Use of the Clubhouse model for vocational rehabilitation to increase employment outcomes
  • Targeted peer-provided interventions
  • Illness Management and Recovery in combination with pharmacotherapy
  • Virtual reality interventions
  • Augmenting pharmacotherapy with acupuncture
  • Case management to improve preventive screening and medical outcomes
  • Specific, integrated, nonintegrated, or psychosocial treatments in addition to the usual care for schizophrenia and comorbid substance use disorder

Department of Veterans Affairs and Department of Defense. (2023). VA/DoD clinical practice guideline for management of first- episode psychosis and schizophrenia (version 1.0). Retrieved December 2023
from https://www.healthquality.va.gov/guidelines/MH/scz/VADoDCPGSchizophreniaCPG_Final_508.pdf