# INTEGRATE: international guidelines for the algorithmic treatment of schizophrenia - The Lancet, 31 March 2025
I would translate this into Russian, but I’m translating slowly, it has been so since November 2020, that’s why I’m a food delivery courier now, not a translator anymore. I find it extremely hard to focus and plan actions.
Summary:
Schizophrenia is a mental illness involving multiple symptom domains and is often associated with substantial physical health comorbidities. Guidelines exist, but these tend to be country-specific and are often missing a concise yet comprehensive algorithmic approach. From May 1, 2023, to Jan 1, 2025, International Guidelines for Algorithmic Treatment (INTEGRATE) authors from all UN regions collaborated to develop a consensus guideline focused on the pharmacological treatment of schizophrenia. Following an umbrella review of the literature, input from expert workshops, a consensus survey, and lived experience focus groups, a consensus algorithmic guideline and associated digital tool were developed. Key recommendations include a focus on metabolic health from treatment initiation, timely assessment and management of non-response, symptom domain-specific interventions, mitigation of side-effects, and the prompt use of clozapine in cases of treatment resistance.
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This is pretty interesting.
Long story, but when I was in college I took a Sociology of Mental Illness class.
We learned about the different approaches from around the world in viewing, addressing, and treating schizophrenia-spectrum illnesses.
It’s a good thing to standardize treatment across the board as it could potentially ensure access to and quality of care, but maybe some countries and cultures might have a different (and more beneficial) way of tackling certain issues— such as social integration for example— that may get lost amongst these potential new guidelines.
Just a thought, thanks for sharing 
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It is interesting that you took that course in College.
I wonder if you had any symptoms at that time? And, if you did have any symptoms, were you able to recognize that you may be experiencing those symptoms?
I had delusions for years before I got any diagnosis. I didn’t recognize them as delusions. So, I was outside my College (of course not knowing I had schizoaffective at all), and while I was standing and having a coffee, something struck me: That someone was making me believe that I was like Russel Crowe in the beautiful mind, deluded (there is a long backstory to who that someone was, but she wasn’t too distinct from Jennifer Conelly in terms of appearance) when I knew what, well, tricks they were pulling on me. I would be diagnosed long after that, but that is the closest I came to having an impulse that I was experiencing delusions, and, of course, the delusions made me reject that impulse as outrageous.
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That must have been a really tumultuous time experiencing delusions and stuff before you got diagnosed and knew/were told what was really going on. Hopefully you’re doing much better now
Had you watched A Beautiful Mind before experiencing those types of delusions? Or did you watch the movie after and something kind of clicked for you?
Haha yea, it’s a little ironic that I ended up taking that course in school— wasn’t prodromal yet, but I was already experiencing some stuff early on, I just didn’t know what it was and was too young to know any better.
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The disease might manifest differently in different cultures and populations too. It’s not definitive yet but it’s very likely that there are different subtypes of the disease so one subtype might be more common amongst one group of people then it is in another. An umbrella approach might not be as effective if this is the case. The approach is algorithmic though so maybe it’s comprehensive enough to account for that.
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Yes, I had watched it. That is why the impulse came that perhaps I was like him in that moment, and came not as a break, but something that would further reinforce the delusions: That someone was trying to convince me that I was like him, and that that person was playing tricks on me in real life. That is the way the brain came kind of tricks you. Those delusions that started in 2005, I would only get a break from them in 2015-2016, when an impulse came from a “foreign source” (planted in my head) that those earlier fragments of my life which I considered to be so true were false. But, the delusions, in a sense progressed, because that break was “planted by the voice” in my head, it was not my thought. So, the voices were an external source, but the earlier delusions which lasted 10 years or so were probably false. This is when I realized something was wrong, and I started taking medication consistently. But I couldn’t doubt that the voices weren’t the CIA doing telepathy with me.
From 2005 and 2010, I had many friends, was very functional, and though my cognitive abilities were receding, I was able to pass Actuarial Exams, complete a year of Master’s at Columbia with a 3.7 GPA. But, this is where the CIA, the voices, take over.
I understand what you mean regarding not knowing then that the issues you were facing could be related to mental health. But, did any of your education enable you to have insight sooner as the illness progressed? Like, did help you in any way?
I took a Psychology course in College, but don’t remember studying anything about psychopathology. I guess it wouldn’t have mattered either way in my case, it is one thing to study these things, another to have the lived experience of delusions because they are so real in the moment.
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Wow, it sounds like you had some really complex delusions around that time. I’m glad though that you were able to have a lot of friends and do so well in school before those voices and CIA delusions took over. Apparently, that’s a super common topic for a lot of folks.
Mine included believing there was a deep conspiracy afoot at my university— luckily I was already done with classes and just on campus waiting for graduation day as a senior, so I was on my way out and my grades didn’t dip or anything.
Delusions are hard to break for sure. I think meds help to a certain extent, but on top of that sometimes it requires a ton of trust, patience, and effort in trying to reframe one’s thoughts. Easier said than done for sure though.
Nah, taking that mental health course didn’t help me at all while I was going through psychosis, haha 
. But defos afterwards— after I regained my mental faculties and with time— I’m now able to kinda view SZ and its related conditions objectively, but with kind of an experienced and nuanced background at the same time, if that makes any sense.
Very true and well said .
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