Pharmacological treatments for schizoaffective disorder, which is a type of psychotic disorder, are typically initiated and managed by secondary care mental health services NICE CKS,NICE CKS.
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 NICE CKS,NICE CKS. 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 NICE CKS,NICE CKS.
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 NICE CKS,NICE CKS. 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 NICE NG181.
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 NICE CG178. After this period, the responsibility for monitoring may be transferred to primary care under shared care arrangements NICE CG178.