CONTROVERSIES IN PSYCHIATRY IN 2013 

Minerva Psichiatrica 2013 June;54(2):101-13

Copyright © 2013 EDIZIONI MINERVA MEDICA

language: English

Practical issues in the treatment of schizophrenia

Ceskova E. ^{1, 2}

¹ Central European Institute of Technology (CEITEC), Masaryk University Brno, Czech Republic; ² Department of Psychiatry Faculty Hospital Brno, Brno, Czech Republic

Treatment should be evidence-based, measurement-based, complex (including pharmacotherapy, psychosocial intervention, and physical health care) and individualized (tailored to the patient). The basis of schizophrenia treatment is still pharmacotherapy. The first generation of antipsychotics (FGAs), known as typical APs, was discovered in the 1950s. Most second generation antipsychotics (SGAs), known as atypical APs, have been developed more recently. SGAs present some advantages in the treatment of certain treatment domains. The binding affinity of APs for specific neuroreceptors is associated with the therapeutic effect, but also with adverse events. The choice of AP for the individual patient should be guided by the side effect profile of the drug, patient experience with certain side effects, previous patient response to certain APs (e.g., individualized treatment), and potential interactions with other prescribed medication. There are some special clinical features influencing the choice of AP treatment (negative, cognitive, depressive and catatonic symptoms, agitation, non-adherence, pharmacoresistance). These features are discussed in more details. In the future more targeted therapies will be available, offering and enhance efficacy and hopefully also safety.