NEWS 13
ausdoc. com. au 20 MARCH 2026
NEWS 13
Schizophrenia guidelines loom
Rachel Carter PSYCHIATRISTS have drawn up new schizophrenia management guidelines that would, if endorsed, mark the first Australasian update in a decade.
The Royal Australian and New Zealand College of Psychiatrists( RANZCP) last published guidelines in 2016, but has been warning doctors that they are not considered current because they are more than five years old.
Despite an estimated 200,000 people having schizophrenia, Professor Shuichi Suetani, co-author of the new draft, said no new blockbuster treatments had emerged in the last 10 years.
“ What there has been is a much improved and increased focus on the physical health of people with mental illness,” the Queensland psychiatrist told Australian Doctor.
As such, the proposed guidelines outlined in the Australian and New Zealand Journal of Psychiatry say every patient should at least be offered“ multimodal lifestyle interventions” as part of routine care.
“ This could be a combination of nutrition counselling, weight management, physical activity programs, health education and motivational interviewing,” Professor Suetani said.
The draft has seven sections, including physical health assessment, pharmacological treatment, and family, carers and whānau— the Māori term for extended family.
The guidelines themselves are supported by four principles, including shared decision-making to ensure that the person with schizophrenia is the primary driver of their care as far as possible, collaboration with family, and adequate training and supervision for clinicians.
The fourth principle is“ thoughtful” medication management, aiming“ for the lowest effective dose with a tolerable and manageable adverse effect profile”, the journal paper says.
Aripiprazole, brexpiprazole, cariprazine and lurasidone are the recommended first-line antipsychotics, selected for their“ more favourable cardiometabolic profiles”.
None except aripiprazole was available in Australia back in 2016.
“ Some of the medications we recommend are much gentler in terms of side effects, including less side effects related to heart or metabolic conditions, like diabetes,” Professor Suetani said.
“ We’ ve also got a lot more evidence now in terms of using things like metformin [ alongside antipsychotics ], which helps people not gain weight after starting the medication.”
Unlike the 2016 RANZCP guidance, the new guidelines were developed using the Grading of Recommendations, Assessment, Development and Evaluation( GRADE) approach, with 18 recommendations deemed strong and 15 deemed weak.
The authors acknowledged that not using consensus-based recommendations resulted in a“ narrower scope”,
‘ There has been an increased focus on physical health.’
COPD
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ASTHMA
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THINK TRIMBOW
† 1 beclometasone / formoterol / glycopyrronium
† Trimbow( BDP / FF / G) 100 / 6 / 10 and 200 / 6 / 10 are indicated for maintenance treatment in adults with asthma not adequately controlled with a maintenance combination of medium dose or high dose ICS / LABA respectively, and who experienced ≥1 exacerbation( s) in the previous year. 1 Trimbow 100 / 6 / 10 is indicated in adults with moderate to severe COPD who are not adequately treated by ICS / LABA or LABA / LAMA. 1
The only extrafine * triple therapy PBS listed for severe adult asthma in 2 strengths and COPD( 100 / 6 / 10). 2
* Mass median aerodynamic diameter < 2 µ m. 1
limiting nuance on several key topics, including management options if clozapine therapy cannot be continued, approaches to risk assessment, medication adherence and mental health legislation.
People with experience of schizophrenia were involved in developing the guidelines, including one of the authors, while a consumer consultation group of seven people provided feedback throughout the development process.
Professor Suetani said the need for new guidance was best summarised by a member of this group, who said“ it gives psychiatrists a path to follow”.
There remained“ a lot we don’ t know” about the complex disorder, he added.
Australian Doctor understands that the RANZCP is currently reviewing the guidelines to decide whether to officially endorse them.
PBS Information: Trimbow Authority required( STREAMLINED). Severe asthma. Chronic Obstructive Pulmonary Disease( 100 / 6 / 10 mcg presentation only). Criteria Apply. Refer to PBS for full information. Please review Product Information before prescribing. Product Information is available by scanning the QR code.
Abbreviations: COPD: chronic obstructive pulmonary disease; ICS: inhaled corticosteroid; LABA: longacting beta 2 agonist; LAMA: long-acting muscarinic antagonist; PBS: Pharmaceutical Benefits Scheme. References: 1. Approved Trimbow Product Information. 2. Pharmaceutical Benefits Scheme. pbs. gov. au. Chiesi Australia Pty Ltd. Level 7, Suite 1, 500 Bourke Street Melbourne VIC 3000, Australia. Tel: + 61 3 9077 4486; Email: medinfo. au @ chiesi. com. Copyright © Chiesi 2025. All rights reserved. Date of preparation: Nov 2025. AU-TRI-2500089. CHIE000263
Professor Shuichi Suetani.
CHIE00263O Australian Doctor 210x273mm _ FA. indd 1 17 / 2 / 2026 2:52 pm