The future of pharmacotherapy for schizophrenia

Although enormous progress has been made in the treatment of schizophrenia, and the use of existing pharmacologic agents can have a dramatic effect on the short- and long-term management of the disorder, enormous challenges and unmet needs continue to exist. Despite the introduction of a second generation of antipsychotic medications, many patients continue to derive inadequate benefits from available agents. Negative symptoms and cognitive dysfunction, and decrements in psychosocial and vocational functioning, often continue to persist despite our best available treatments. Medication adherence remains a constant challenge and has not been dramatically improved by the new-generation antipsychotic drugs. Since all currently marketed antipsychotic agents possess some degree of dopamine antagonist effects, the role of other neurotransmitters in the primary antipsychotic activity remains largely unclear. It is possible that different domains of disease effects might benefit from different specific classes of medications, yet research in this area is not highly developed. The promise of further discoveries in genetics leading to new treatment targets and better predictors of treatment response (both therapeutic and adverse) is enormously exciting, but these developments will require years of additional research. The field must balance the need to make the most informed and thorough use of available agents with a sense of both excitement and patience as we work toward other approaches.