Pharmacotherapy of Schizophrenia

Abstract

Antipsychotic medications remain the foundation of pharmacological treatment of schizophrenia. Although there has been significant progress over the past decade resulting in the introduction of several new agents, all currently available antipsychotics modulate brain dopamine systems and can essentially be classified into two groups: conventional (first‐generation) and atypical (second‐generation) antipsychotics. Many of the second‐generation antipsychotics are believed to offer advantages over first‐generation agents in the treatment for schizophrenia. However, the pharmacological properties that confer the different therapeutic effects of the new generation of antipsychotic drugs have remained elusive, and certain side effects can still impact patient health and quality of life. Moreover, the efficacy of antipsychotic drugs is limited prompting the cIinical use of adjunctive pharmacotherapy to augment the effects of treatment. In addition, the search for novel and nondoparninergic antipsychotic drugs has not been successful to date, though numerous development strategies continue to be pursued, guided by various pathophysiologic hypotheses. This article provides a review and critique of the current therapeutic armamentarium for treating schizophrenia and drug development strategies and theories of mechanisms of action of antipsychotics, and focuses on novel targets for therapeutic agents for future drug development.

The Relationship Between Change in Working Memory and Change in Functional Outcome in a Cognitive Remediation Treatment Trial in Schizophrenia

“…Second-generation antipsychotics produce fewer EPS at therapeutically effective doses and are sometimes preferred over FGAs for this reason (Sharif, Miyamoto, & Lieberman, 2007). SGAs are also known as atypical antipsychotics because they have a lower affinity for D2 receptors and a higher affinity for serotonin (5-HT)2A receptors than FGAs.…”

“…SGAs are also known as atypical antipsychotics because they have a lower affinity for D2 receptors and a higher affinity for serotonin (5-HT)2A receptors than FGAs. 5-HT2A antagonism has been found to increase dopaminergic transmission in the nigrostriatal pathway which can reduce the incidence of EPS (Sharif et al, 2007). Despite the apparent reduction in EPS found with the administration of SGAs versus FGAs, there does not appear to be a significant difference in the efficacy of the two drug classes (Lieberman et al, 2005).…”