What are the recommended pharmacological treatments for schizoaffective disorder in primary care settings?

Pharmacological treatments for schizoaffective disorder, which is a type of psychotic disorder, are typically initiated and managed by secondary care mental health services ¹,².

If a person with a psychotic disorder is being managed solely in primary care, re-referral to secondary care is recommended if there is a poor or partial response to treatment, poor treatment adherence, a significant decline in functioning, or the development of intolerable or medically important adverse effects from medication ¹,². Re-referral is also necessary if comorbid alcohol or drug misuse is suspected, or if there is a potential risk to the person or others ¹,².

In secondary care, people diagnosed with a psychotic disorder are likely to be offered a therapeutic trial of an oral antipsychotic, which can be either first-generation or second-generation ¹,². For individuals with complex psychosis whose symptoms have not responded adequately to clozapine alone, secondary care may consider augmenting clozapine with an antipsychotic, a mood stabiliser for significant affective symptoms, or an antidepressant for significant depressive symptoms ³.

The secondary care team maintains responsibility for monitoring a person's physical health and the effects of antipsychotic medication for at least the first 12 months or until their condition has stabilised ⁴. After this period, the responsibility for monitoring may be transferred to primary care under shared care arrangements ⁴.