CLINICAL HANDBOOK OF SCHIZOPHRENIA

150 II. ASSESSMENT AND DIAGNOSISTABLE 15.4. Recent Medication Algorithms/Guidelines for SchizophreniaAlgorithm/guideline Content UtilityPractice Guideline for theTreatment of Patients withSchizophrenia (AmericanPsychiatric Association, 2004)Expert Consensus Guidelines(McEvoy, Scheifler, & Frances,1999)InternationalPsychopharmacology AlgorithmProject (IPAP) (www.ipap.org)Patient Outcomes ResearchTeam (PORT) (Lehman et al.,2004)Texas Medication AlgorithmProject (TMAP) (Moore et al.,2007)Comprehensive literaturereview, some sequencerecommendations.Based on expert consensusaround case examples. Definedsequence of antipsychoticchoices, up to clozapine.Expert consensus. Definedsequence of antipsychoticchoices, up to clozapine. Linksto specific recommendationsbased on individual side effectsand associated symptoms.Set of recommendations basedsolely on results of randomizedcontrolled trials (RCTs).Expert consensus. Definedsequence of antipsychoticchoices, including clozapinefailures/refusals.Not manualized. No specificmeasures of or criteria for“response.”Not manualized. No specificmeasures of or criteria for“response.”Interactive website. Discussionswith references go with eachproblem area andrecommendation. No specificmeasures of or criteria for“response.”Not manualized. Limited inscope to questions addressed byRCTs. Good basis for qualitycontrol measures.Manual on website. Specificsymptom rating scales andcriteria for “response.” Formsfor documentation.cific goal of the plan should link back to one of the consumer’s stated goals. Goals oftenexpressed by consumers include a desire to obtain work or return to school, to find a girlfriend,or to get along better with family members. Although some goals are not immediatelyattainable for a specific client (e.g., returning to work), each goal included in thetreatment plan may be viewed as a stepping-stone toward the individual’s ultimate ambition.All too often, treatment goals (e.g., medication adherence, grooming) are imposedbecause members of the treatment team are convinced that such goals are in the best interestsof the client. Although the treatment team’s view may be accurate, clients must endorsetreatment plan goals as their own. If the treatment team’s goal can be tightly linkedwith what the client wants, progress toward the goal is more likely.Assessment of Psychosocial IssuesThe development of a good treatment plan for psychosocial functioning requires a detailedassessment of the client’s residual symptomatology, medication adherence, and social andenvironmental context. In addition, the consumer’s ability to perform ADLs, to interact socially,and to work need to be examined to identify appropriate targets for intervention.Targets of the Psychosocial Treatment Planand Potential TreatmentsMedication AdherenceMany aspects of the patient’s functioning can be targeted by psychosocial treatment.Given the vast array of potential treatment targets, it is important to prioritize goals.