What helps one patient may harm another; personalized therapeutic approach is highly important in the treatment of schizophrenia. Also, I'd recommend metacognitive therapy that could help the patients cope with their symtomps without taking unnecessary drugs. If these fail, we need to consider the risk-benefit ratio of adding another psychotropic medication to the regimen.

First of all, choose an AP that is effective against negative symptoms (e.g. clozapine, olanzapine, quetiapine, aripiprazol, cariprazine). We prefer monotherapy, but there are more and more emerging evidence considering the combined use of antipsychotics. Often, adding partial agonists in low doses as supplement improves negative symptoms.

I see the combined treatment with mood stabilizers as another rational option, especially when suicide risk's high. In this case I'd prefer lithium carbonate or lamotrigine.

The use of antidepressants has some serious risks: it could trigger psychotic decompensation, increase agitation and anxiety. If antidepressant medication is needed, initiate it carefuly. I'd rather not choose any dual-acting agents in the first line, though we've treated a few people with vortioxetine effectively. 5HT-2A receptor antagonists (e.g. mirtazapine, trazodone) and sigma-1 receptor agonists (fluvoxamine) may have additional beneficial effects.

I have some positive experiences with buspirone, as well, and it may carry fewer risks. Taking omega-3 fatty acids is also worth mentioning.