The term antipsychotic drug (APD), also called a neuroleptic, refers to medications currently prescribed for the treatment of neuropsychiatric diseases that display psychotic features (e.g., schizophrenia) [1]. Classification of APDs is mainly based on the profile of their adverse effects; in particular, liability to produce extrapyramidal symptoms (EPS). Accordingly, typical (or first generation) and atypical (or second generation) drugs have been differentiated. Typical APDs are effective at controlling the so-called positive symptoms of schizophrenia; hallucinations and delusions, but they are more likely to produce undesired motor effects than atypical APDs [2]. However, this kind of classification has been questioned and, in fact, each APD may be considered as having a unique set of properties [3]. Meanwhile, it is important to note that a substantial number of patients do not respond adequately to existing APDs, and in particular, the negative symptoms of schizophrenia, which include cognitive deficits, social withdrawal, anhedonia and avolition, are hardly ameliorated by current treatments. Thus, there exists a clinical need for the development of mechanistically novel and more efficacious APDs.
The dopaminergic hypothesis of schizophreniaIt is well accepted that dysregulation of dopaminergic neurotransmission is central to most psychotic processes, including schizophrenia. The dopaminergic hypothesis concerning schizophrenia states that hyperactivity in the mesolimbic dopamine pathway concurs with hypofunction in the mesocortical dopamine pathway [4]. Accordingly, reducing signaling via mesolimbic dopamine D 2 receptors (D 2 Rs) is probably the main mechanism through which antipsychotic therapeutics function. Indeed, APDs are either antagonists or partial agonists for D 2 Rs. Importantly, the level of antipsychotic occupancy of striatal D 2 Rs is related to the appearance of adverse motor effects such as EPS; neuroimaging studies have revealed that a D 2 R occupancy of above 80% is associated with the appearance of EPS [5]. Interestingly, while typical APDs such as haloperidol may result in this degree of occupancy at therapeutic doses, atypical ones such as clozapine achieve antipsychotic efficacy at lower occupancy levels, which may explain why they are less likely to produce EPS [5].