World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Schizophrenia Part 3: Update 2015 Management of special circumstances: Depression, Suicidality, substance use disorders and pregnancy and lactation

Abstract

These updated guidelines are based on the first edition of the World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of schizophrenia published in the years 2005 and 2006. For this 2015 revision, all available publications pertaining to the biological treatment of schizophrenia were reviewed systematically to allow for an evidence-based update. These guidelines provide evidence-based practice recommendations which are clinically and scientifically relevant. They are intended to be used by all physicians diagnosing and treating patients with schizophrenia. Based on the first version of these guidelines a systematic review, as well as a data extraction from national guidelines have been performed for this update. The identified literature was evaluated with respect to the strength of evidence for its efficacy and subsequently categorised into six levels of evidence (A–F) and five levels of recommendation (1–5). This third part of the updated guidelines covers the management of the following specific treatment circumstances: comorbid depression, suicidality, various comorbid substance use disorders (legal and illegal drugs), and pregnancy and lactation. These guidelines are primarily concerned with the biological treatment (including antipsychotic medication and other pharmacological treatment options) of patients with schizophrenia.

Key words::

• schizophrenia
• comorbid depression
• suicidality
• comorbid substance use disorder
• pregnancy

Acknowledgements

We would like to thank Anja Dorothée Streb, Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University Munich, for general and editorial assistance in preparing these guidelines. The draft version of the guidelines was sent to all presidents of the various national societies of biological psychiatry that are members of the WFSBP; our thanks are addressesd to those presidents who have sent us their comments on the guidelines.

Statement of Interest

Alkomiet Hasan has been invited to scientific meetings by Lundbeck, Janssen-Cilag, and Pfizer, and he received paid speakership by Desitin, Otsuka and the Federal Union of German Associations of Pharmacists. He was member of the Roche Advisory Board. Peter Falkai was the honorary speaker for Janssen-Cilag, AstraZeneca, Eli Lilly, Bristol-Myers-Squibb, Lundbeck, Pfizer, Bayer Vital, SmithKline Beecham, Wyeth, and Essex. During the last 5 years, but not presently, he was a member of the advisory boards of Janssen-Cilag, AstraZeneca, Eli Lilly, and Lundbeck. Thomas Wobrock was the honorary speaker for Alpine Biomed, AstraZeneca, Cerebromed, Bristol-Myers-Squibb, Eli Lilly, I3G, Janssen-Cilag, Novartis, Lundbeck, Sanofi-Aventis, Otsuka, and Pfizer, and has accepted travel or hospitality not related to a speaking engagement from AstraZeneca, Bristol-Myers-Squibb, Eli Lilly, Janssen-Cilag, and Sanofi-Synthelabo; he is a member of the advisory board of Janssen-Cilag and has received a research grant from AstraZeneca, I3G, and AOK (health insurance company). Jeffrey Liebermann was/is a member of the advisory boards of Bioline, Intracellular Therapies, Alkermes, Lilly and Pierre Fabre. He received research support/grants by Allon, GlaxoSmithKline, Lilly, Merck, Novartis, Pfizer, Psychogenics, LTD, Sepracor and Targacept. He holds a patent by Repligen. Birte Glenthøj is leader of a Lundbeck Foundation Center of Excellence for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS) which is partially financed by an independent grant from the Lundbeck Foundation based on international review and partially financed by the Mental Health Services in the Capital Region of Denmark, the University of Copenhagen, and other foundations. She has nothing else to declare. Wagner F. Gattaz reports no conflict of interest. Florence Thibaut is a member of the Sertindol Study International Safety Committee. Hans-Jürgen Möller received honoraria for lectures or for advisory activities or received grants by the following pharmaceutical companies: Astra-Zeneca, Eli Lilly, Janssen, Lundbeck, Pfizer, Schwabe, Servier, Otsuka and Takeda. He was president or in the Executive Board of the following organisations: CINP, ECNP, WFSBP, EPA and chairman of the WPA-section on Pharmacopsychiatry.