Current and future treatment modalities in schizophrenia: novel antipsychotic drugs and cognitive therapy

Abstract

In 60 years of use of antipsychotic drugs in schizophrenia, the only definite advance has been the introduction of clozapine. Some but not all other atypical or second-generation drugs may have small therapeutic advantages over conventional antipsychotics, but this remains controversial. New entrant atypicals seem unlikely to be therapeutically superior to conventional drugs, and glutamatergic drugs have yet to fulfill their theoretical promise. There is considerable current interest in novel mechanisms of antipsychotic action, but no such drugs have yet reached market authorization. A psychotherapeutic intervention, cognitive behavioral therapy has also found a place in the treatment of schizophrenia. However, the size of its effect against psychotic symptoms is small, and current evidence suggests no effect against negative symptoms or in reducing relapse.

Keywords::

• antipsychotic
• cognitive behavioral therapy
• dopamine
• glutamate
• mechanism of action
• schizophrenia

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Clozapine shows superior efficacy to conventional antipsychotics; the occasional claims that this is not the case lack credibility.

• There is an unresolved controversy over whether or not some other atypical antipsychotics have therapeutic advantages over conventional drugs.

• The performance of recent entrant aytpicals has been disappointing.

• Non-dopamine mechanisms of action are of great interest, but none has yet provided an effective antipsychotic drug.

• There is more activity in respect of adjunctive treatment than monotherapy.

• The effectiveness of cognitive therapy in schizophrenia is emerging as limited.