title: Raising the standard of care in the treatment of schizophrenia: Yes we can!
abstract: OBJECTIVE
  In response to evidence of deteriorating outcomes of people with schizophrenia we recently published a critical review in the journal concerning why outcomes for schizophrenia are not improving. A published commentary on our review raised criticisms that we aim to address herein.
  
  
  METHODS
  Published data related to four issues raised in the commentary were reviewed.
  
  
  RESULTS
  There is a body of evidence that supports the possibility of dramatic improvements in treatment effectiveness, presented in our critical review, and these can be achieved within existing financial resources and present day understanding of the pathophysiology of schizophrenia. However, the commentary leads us to highlight four current obstacles to improving treatment effectiveness: (1) the belief of many psychiatrists that long-term antipsychotic medication raises the cardiovascular mortality rate in schizophrenia when the opposite is almost certainly the case; (2) the need to improve psychiatrist training in diagnostic and communication skills, especially with first episode presentations; (3) the requirement for comprehensive and structured assessment of the highly prevalent deficits in insight and decision making capacity associated with schizophrenia; and (4) the need for improved intervention design to minimise the impact of these deficits on treatment choice and refusal.
  
  
  CONCLUSIONS
  With a sense of professional urgency, a genuinely respectful and caring partnership between clinicians, affected individuals and their families, and researchers, with relative little innovation, we conclude that the standard of care can definitely be raised now in the treatment of schizophrenia.
authors.affiliation: 1 Discipline of Psychiatry, Royal Brisbane Clinical School, School of Medicine, The University of Queensland, Herston, QLD, Australia.|2 Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia.
authors.forename: Stanley Victor
authors.initials: SV
authors.lastname: Catts
authors.affiliation: 2 Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia.
authors.forename: Brian
authors.initials: B
authors.lastname: O'Toole
mesh_terms: D014150:Antipsychotic Agents / Q000009:adverse effects / Q000494:pharmacology*; D002318:Cardiovascular Diseases / Q000139:chemically induced / Q000517:prevention & control*; D006801:Humans; D011570:Psychiatry / Q000592:standards*; D012559:Schizophrenia / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D059039:Standard of Care / Q000592:standards*
chemical_list: D014150:Antipsychotic Agents
keywords: Schizophrenia; decision making capacity; insight; outcomes; treatment