MJA practice essentials. Managing schizophrenia in the community.

There is an increasing expectation that general practitioners will be more involved in treating people with schizophrenia. Newer drugs are associated with better clinical outcomes, especially in relation to negative symptoms (ie, apathy, under activity, slowness, social withdrawal). Some patients make a full recovery or are quite functional between episodes. Identifying early warning signs will lead to reduction of disability. Side effects of medication must be treated vigorously and expediently to enhance compliance. Secondary symptoms of dysphoria and depression must be treated to prevent suicide. Issues of alcoholism and substance abuse must be addressed, providing education on their implications for the course of the illness. People with schizophrenia need continuity of care, which the general practitioner may be best placed to provide because of a long-term commitment to the patient. Involvement with the family (education, support and a collaborative approach in monitoring and supporting the patient's well-being) is vital.