Navigating Schizophrenia Treatment: Balancing Symptom Relief and Long-Term Needs

Abstract

Schizophrenia is a long-term disease that needs to account for acute symptom control and long-term treatment needs such as relapse prevention, remission, and safety. The aim of the present book chapter was to summarize available literature data and guidelines on how to treat specific symptoms of schizophrenia and what aspects to consider long term. Looking at single symptoms, clozapine was better than all other antipsychotics in addressing positive and hostility symptoms of schizophrenia: however, it is not first-line treatment. Cariprazine showed superior efficacy in treating primary negative symptoms and is treatment of choice for these symptoms. Additionally, partial agonists (aripiprazole, brexpiprazole, cariprazine) were better in addressing comorbid substance use, while quetiapine, cariprazine, and olanzapine/fluoxetine showed advantages in treating mood disorders. In long term, there was no difference between antipsychotics in addressing relapse and remission; however, distinct differences in safety aspects are seen; overall, newer generation antipsychotics (aripiprazole, brexpiprazole, cariprazine, and lurasidone) are favored over other antipsychotics. In summary, careful consideration should be applied when choosing the right treatment for schizophrenia, accounting for prevalent symptoms, longitudinal aspects, psychiatric and somatic comorbidities as well as preference of patients.