Progress defined--short-term efficacy, long-term effectiveness

The management of schizophrenia continues to represent an enormous challenge, despite improvements in both drug therapy and family and community interventions. Treatment expectations have shifted from the primary goal of controlling positive symptoms to a more comprehensive approach, with the aim of providing relief in all symptom domains, preventing relapses, improving compliance and ultimately improving functional outcomes in patients with schizophrenia. The advent of a new generation of 'atypical' antipsychotics should aid clinicians in meeting these goals. These agents combine high antipsychotic efficacy with improved tolerability profiles, mainly through a low liability for extrapyramidal symptoms. There is enough evidence from randomized, double-blind trials to demonstrate efficacy of atypical antipsychotics in improving global psychopathology, positive, negative, affective and cognitive symptoms, as well as preventing relapse during long-term use. These drugs may, therefore, provide clinicians with a new and important addition for first-line management of schizophrenia.