The pharmacological treatment of schizophrenia: How far have we come?

Abstract

Schizophrenia is a chronic and often severe mental disorder for which antipsychotic drugs are the cornerstone of treatment. Although the essential mechanism of action of these drugs has not changed much since they were first discovered in the 1950s, there have been numerous advances in the context in which these drugs are prescribed, as well as in the considerations for their optimal use. In this review, we summarize five selected issues in which the psychopharmacological treatment of schizophrenia has most evolved. Namely, these are the shift of outcomes of interest from symptoms to recovery, the development of stratified approaches to select the most appropriate treatment for each individual, the recognition of treatment nonadherence as a critical factor determining outcomes, the recommendations for maintenance treatment, and, finally, the promise of new antipsychotic compounds that innovate in their mechanisms of action, improving efficacy/safety profiles. Finally, we discuss how some of these advances have already delivered to improved outcomes in the real world, whereas others have demonstrated efficacy under optimal circumstances yet have not been translated into better outcomes in the community. Thus, the road ahead includes both identifying novel treatments that engage the psychopathology of the illness and improve the efficacy/tolerability profile of currently available agents, as well as developing interventions that mitigate the barriers for the use of novel interventions, some of them already existing, in the real world.

A Bibliometric Analysis of The Schizophrenia Publications of South East Asia in 2002-2023

“…The research about pharmacological treatment showed progress, as seen in the overlay visualizations that now research has shifted toward the new generation of atypical antipsychotics. The research about treatment are still evolving to develop interventions that resulting in efficacy of the treatment (Ganguly et al, 2018) (Rubio & Kane, 2022). The forth clusters described the genetic and mechanism of schizophrenia as shown by keyword -brain‖, and -polymorphism‖ as schizophrenia is strongly correlated with genetic predisposition (Laksono et al, 2019) (Maritska et al, 2022).…”

Second International Consensus Study of Antipsychotic Dosing (ICSAD-2)

“…Since the introduction of chlorpromazine and haloperidol seven decades ago, the number of drugs for psychosis has steadily increased with new drug entities and formulations resulting in dozens of treatment options for schizophrenia and other major psychiatric disorders (Rubio and Kane, 2022;Taylor et al, 2021). Competent use of drugs for psychosis requires clinical experience and knowledge of sound dosing practices.…”

Inhibitors of Endocannabinoids’ Enzymatic Degradation as a Potential Target of the Memory Disturbances in an Acute N-Methyl-D-Aspartate (NMDA) Receptor Hypofunction Model of Schizophrenia in Mice

“…The available pharmacotherapy of schizophrenia primarily focuses on the control of psychosis and has a limited efficacy on the negative symptoms. On the other hand, cognitive disorders in the course of schizophrenia are not subject to treatment with classic antipsychotic drugs, and additionally, sometimes such pharmacotherapy may exacerbate these disorders [2]. This is a very important medical problem because the large changes in cognitive functions are very often noticeable in people suffering from schizophrenia.…”