First Argentine Consensus on the Management of Schizophrenia: Section three. Recommendations foran Integrated Treatment Approach

Abstract

This document represents the third part of the First Argentine Consensus on the Management of Schizophrenia and aims to synthesize the most up-to-date scientific evidence on therapeutic approaches for adult patients with this disorder. Following the methodology described in the first part of the Consensus, a multidisciplinary panel of experts conducted a comprehensive and systematic review of the available literature, followed by a structured discussion and consensus process, from which the recommendations presented in this section were derived. This part of the Consensus focuses on the integrated treatment of schizophrenia in adults, addressing key aspects such as considerations prior to pharmacological prescription, management of acute exacerbations, and first- and second-line pharmacological treatments. In addition, it provides an in-depth analysis of the role of clozapine, the use of long-acting injectable antipsychotics (LAIs), criteria and strategies for antipsychotic switching, as well as augmentation and combination treatment strategies. The document also reviews the evidence supporting adjunctive biological interventions, including electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS). Furthermore, it addresses core clinical concepts such as treatment adherence, definitions of response, remission, and recovery, relapse prevention, and maintenance treatment. Additional sections focus on the management of psychiatric and medical comorbidities, the identification of pseudoresistance to treatment, and, finally, the psychosocial treatment of schizophrenia, emphasizing the importance of a comprehensive, longitudinal, and person-centered approach to care.