Psychopharmacological treatment of schizophrenia: What do we have, and what could we get?

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Abstract

Antipsychotic drugs for the treatment of schizophrenia arrived in the clinic in the fifties of the previous century and have since been the most effective treatment for patients with this devastating disorder. In spite of the more than half a century of clinical experience, and the introduction of a large number of chemical divers antipsychotic drugs, several recent large, multi-center studies have shown that, although novel (second generation) antipsychotics seem to be tolerated somewhat better (especially in relation to neurological side effects), their therapeutic potential is comparable to that of first generation antipsychotics. Hence there is still an urgent need for better pharmacological tools to treat schizophrenic patients. The current paper reviews the benefits and shortcomings of the currently available drugs, and gives an outlook towards the drugs and targets that are currently being pursued in clinical trials. Given the uncertainty of the drug discovery process and the relatively poor predictive validity of the currently available animal models, it is, at present, impossible to predict which of these drugs will ultimately become available for treating schizophrenic patients.

This article is part of a Special Issue entitled ‘Schizophrenia’.

Highlights

▸ Antipsychotic drugs (APD) have little effect on negative and cognitive symptoms in schizophrenia. ▸ There appear to be few major differences between first and second generation APDs. ▸ Novel APD strategies focus on serotonin, glutamate, acetylcholine and PDE10. ▸ In addition, novel cognitive enhancer (5-HT6, H3) are being evaluated. ▸ A major breakthrough in therapy has yet to be identified.

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