João M Castaldelli-Maia, Roger M K Ng, Afzal Javed, Julio Torales, Abdelgadir Hussein Osman, Aida Sylla, Alaa Al-Frokh, Alexandre Carpentier, Amine Larnaout, Anderson Sousa Martins-da-Silva, Antonio Ventriglio, Anucha Lachman, Dan J Stein, Dina Aly-El Gabry, Dirceu Mabunda, Eduardo Adrian Leiderman, Egor Chumakov, Emmanuel Mwesiga, Geraldo F Busatto, Germain Manzekele Bin Kitoko, Helio Elkis, Israel Kanaan Blaas, Japhet Myaba, Joseph El Khoury, José Ricardo López Melgar, Kibrom Haile, Kim Savuon, Liliia Panteleeva, Lingjiang Li, Lucas Ribeiro da Rocha, Maryna Skuhareuskaya, Michael Musalek, Oleg Skugarevsky, Padmavati Ramachandran, Pichet Udomratn, Rodrigo Cordoba, Seon-Cheol Park, Souleymane Dit Papa Coulibaly, Thelma Sanchez-Villanueva, Yong Chon Park, Wael Alraas, Norbert Skokauskas, Danuta Wasserman, Wolfgang Gaebel, Peter Falkai
There is a pressing need to address the unique challenges of managing Schizophrenia Spectrum Disorders (SSD) in Low- and Middle-Income Countries (LMICs), where mental health resources are scarce and unevenly distributed. To develop this evidence-based guideline, we conducted a systematic review of the literature, followed by three rounds of Delphi surveys with experts from LMICs. The first two Delphi rounds identified and refined priority topics, while the third assessed their practical applicability in resource-limited contexts. The guideline emphasizes early intervention, continuity of care, and the integration of psychosocial interventions with pharmacological treatment, while explicitly tailoring recommendations to the realities of LMICs. Antipsychotic medications remain central, with second-generation agents recommended as first-line treatment for acute psychosis where available, but with recognition that first-generation agents are often the only accessible option. The guideline also discourages mega-dosing and unnecessary polypharmacy-common practices in some LMICs-in favor of rational monotherapy at the lowest effective dose. Psychosocial interventions are positioned as critical but are reframed for scalability: psychoeducation for patients and families, task-sharing to community health workers and trained lay providers, and reliance on peer support and faith-based networks where specialist services are lacking. The guideline stresses comprehensive care addressing physical, mental, and social needs, including vocational rehabilitation and housing support, while acknowledging barriers such as stigma, insecurity, and climate-related disruptions. Cultural adaptation is emphasized throughout, aligning interventions with local beliefs, social norms, and community structures to promote engagement, adherence, and sustainable outcomes.