Abstract
This article provides an overview of the pharmacological treatment of schizophrenia. Antipsychotic drugs (APDs) are the mainstay pharmacological treatment. All available APDs bind to dopamine (DA) D2 receptors at therapeutic doses and the overwhelming majority of APDs are dopamine (DA) D2 receptor antagonists. APDs show efficacy against the positive symptoms of schizophrenia but have limited efficacy against negative symptoms or cognitive deficits of the disorder. APDs are effective against acute psychotic episodes, and for maintenance treatment to prevent relapse. Clozapine is the APD of choice in treatment-resistant schizophrenia. APDs are associated with significant side effects including extrapyramidal symptoms (dystonia akathisia, parkinsonism and tardive dyskinesia), metabolic disturbances (weight gain, glucose dysregulation and dyslipidemia), neuroleptic malignant syndrome, hyperprolactinemia, cardiovascular risks (hypotension and tachycardia), amongst others. These side-effects contribute to nonadherence. Long-acting injectable (LAI) formulations of APDs, can improve medication adherence and reduce rehospitalization rates. While APDs have transformed the treatment landscape for schizophrenia, a considerable proportion of patients respond sub-optimally and many have side-effects. This highlights the urgent need to develop novel therapeutic agents with distinct mechanisms of action, especially to target negative and cognitive symptoms that are inadequately treated by current APDs.
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