Old and new approaches to drug treatment of schizophrenia

Abstract

AbstractMore than 30 years have passed since the introduction of effective antipsychotic drugs. These drugs have revolutionized both the treatment of patients with schizophrenia and the thinking about the nature of this disorder. During this time, technical improvements have widened the scope of usefulness of these agents. However, no newer drug has been more effective overall than was the first, chlorpromazine. In addition, many patients respond poorly or not at all to drug therapy; others find the side effects of present drugs unbearable. Tardive dyskinesia and tardive psychosis are developments following long‐term treatment that may have serious import. Many questions about drug therapy remain unanswered. Which drug? How much? Intermittent or continual maintenance therapy? What new approaches to treatment can be considered? Atypical neuroleptics that may specifically bind to receptors in the mesolimbic system constitute the major thrust of current drug development. Interest in benzodiazepines as adjunctive agents have revived. The role of propranolol remains uncertain; it seems more to be an adjunctive treatment. Lithium and carbamazepine may be suitable adjuncts for patients who are otherwise refractory to treatment. Use of neuropeptides was greeted with initial enthusiasm, which is rapidly waning as more experience develops. New approaches to drug treatment for schizophrenia are desperately needed.