Pharmacologic treatment of schizophrenia: Current status and future trends

Abstract

The advent of the “atypical” antipsychotics has significantly advanced the pharmacologic treatment of schizophrenia and other psychotic disorders. In contrast to the first-generation conventional neuroleptics, these second-generation antipsychotic agents possess a broader spectrum of efficacy and cause fewer motor side-effects such as extrapyramidal symptoms and tardive dyskinesia. However, despite these advantages, second-generation antipsychotic agents also have significant limitations in terms of efficacy and adverse effects. Several strategies to address these shortcomings are currently under study and some of these are likely to become part of our therapeutic armamentarium in the future. Current short-comings in the pharmacologic treatment of schizophrenia and strategies under investigation to address each of these deficiencies are reviewed. New formulations of existing medications and new antipsychotic agents under development are discussed. Developing adjunctive treatment strategies to address each of the major psychopathological domains in schizophrenia are summarized. The potential application of genetic information to treatment matching in schizophrenia is reviewed, and likely refinements in the practice of evidence-based medicine in the pharmacotherapy of schizophrenia are considered. New molecular targets that are being explored in schizophrenia pharmacotherapy are summarized.