Patient discussions

Education about the illness and medication is important for all patients, so that they understand their condition and to improve medication adherence.[65][214]​​​​​ Unfortunately there is a current lack of evidence-based guidance on communicating a diagnosis of schizophrenia initially.[293] Factors to discuss include prognosis and treatment options; this can be challenging given that these may vary substantially between patients, and also because the patient may be acutely ill.

It is vital that patients consistently take their medication. Any changes should be under the supervision of a physician. Stopping medication abruptly can be dangerous as symptoms are likely to return, which can result in functional decline and danger to self and others. If the patient experiences uncomfortable adverse effects, these issues should be discussed with their physician and appropriate medication adjustments made.

The patient and their caregivers should be advised that if the patient begins to experience worsening symptoms, they should consider calling their doctor, calling 911, or going to the nearest emergency department. This is particularly important if the patient has suicidal thoughts or thoughts of harming others.

Patients should be advised to avoid alcohol and illicit drugs, as these substances can worsen symptoms or cause symptoms to reappear. Patients should be advised to stop smoking.[65]​ Smoking is a major contributor to increased mortality in individuals with serious mental illness.[65]​[294]​​[295]​​​​​ Health education and motivational interviewing approaches can be helpful in those who are ambivalent about stopping cigarette use or who have had prior unsuccessful attempts at smoking cessation.[65]​

Peer-led advocacy groups (such as the National Alliance on Mental Illness [NAMI] in the US) may be particularly helpful in providing practical and emotional support for patients and their families. Such peer support services can provide information about the condition, caregivers, community resources (including groups, opportunities for volunteering, job training, and employment), and economic and legal matters. National Alliance on Mental Illness Opens in new window​​

If a woman becomes pregnant while taking an antipsychotic medication, consideration should be given to consulting an obstetrician-gynecologist or maternal/fetal medicine subspecialist. Some psychotropic medications that are commonly used in patients with schizophrenia are best avoided during pregnancy because of their teratogenic effects. For example, both valproic acid (and its derivatives) and carbamazepine carry an increased risk of fetus malformations, including neural tube defects, especially during the first trimester.[65][177]​​​​ Valproate should not be used to treat women who are pregnant or who plan to become pregnant, or in women of childbearing potential unless other medications have failed to provide adequate symptom control or are otherwise unacceptable.[182][183]​​ In such situations, effective contraception should be used.[183]​ 

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