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Medication treatment of severe mental illness has been advanced and complicated by the introduction of numerous therapeutic agents. Practice guidelines based on research evidence have been developed to help clinicians make complex decisions. Studies of usual care suggest an important potential role for guidelines in improving the quality of medication treatment for people with severe mental illness. The authors review current evidence-based guidelines for medication treatment of persons with severe mental illness. Four categories of guidelines are described: recommendations, comprehensive treatment options, medication algorithms, and expert consensus. The authors note that more research is needed on optimal next-step strategies and the treatment of patients with comorbidity and other complicating problems. They discuss barriers to the implementation of guidelines, and they observe that the potential of guidelines and algorithms to promote evidence-based medication treatment for persons with severe mental illness depends on refinement of tools, progress in research, and cooperation of physicians, nonphysician clinicians, administrators, and consumers and family members. [ABSTRACT FROM AUTHOR]

Schizophrenia is associated with several chronic medical illnesses and a reduced life expectancy. This paper summarizes findings and recommendations from "The Mount Sinai Conference," held at the Mount Sinai School of Medicine in New York on October 17-18, 2002, and discusses the implications for improving medical monitoring of patients with schizophrenia who are managed in outpatient settings from the initiation of treatment. The Mount Sinai Conference involved a diverse panel of experts, including specialists on schizophrenia, obesity, diabetes, cardiology, endocrinology, and ophthalmology. Consensus recommendations included baseline measurement and regular monitoring of body mass index, blood glucose, lipid profiles, signs of prolactin elevation or sexual dysfunction, and movement disorders. Information from such measurements should be considered when selecting or switching antipsychotic agents and should trigger an evaluation of medication when abnormalities are detected.