Strategies for the long-term treatment of schizophrenia: real-world lessons from the CATIE trial.

Patients with schizophrenia have a chronic illness necessitating a biopsychosocial model of care that addresses the multiple dimensions of the disease, including coordinated primary care. Current research, including the lessons learned from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study, shows that in addition to education, adherence, and minimizing adverse effects of psychopharmacologic agents, multimodal long-term treatment strategies are needed to address medical comorbidities, substance abuse, and both cognitive and social deficits. Health care professionals have the responsibility to monitor and help prevent adverse medical outcomes related to treatment with antipsychotics, in light of evidence that patients with schizophrenia are at risk for metabolic disorders and are undertreated for highly prevalent cardiovascular risk factors. These medical problems are particularly challenging in this population due to the chronicity of symptoms, cognitive limitations, social and financial challenges, and compliance issues with recommended medication treatment and therapeutic lifestyle changes. Mental health providers in the United States are now studying models that support the integration of psychiatric and nonpsychiatric medical treatment to address the complexity of multimodal schizophrenia care.