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What does schizophrenia teach us about antipsychotics?
Gary Remington1, Ofer Agid2, George Foussias3
1Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario; Lead, Subspecialty Clinics, Schizophrenia Program, Centre for Addiction and Mental Health, Toronto, Ontario; Senior Scientist, Campbell Family Mental Health Research Institute, Toronto, Ontario; Faculty, Institute of Medical Science, Toronto, Ontario.
Objective:
To examine how advances in our understanding of schizophrenia have shaped thinking about antipsychotics (APs) and their role in treatment.
Method:
Three specific developments in the field of schizophrenia are highlighted: advances in knowledge related to the earliest stages of schizophrenia, specifically the prodrome; reconceptualization of schizophrenia as an illness of multiple symptom domains; and greater clarification regarding the efficacy of clozapine and a new generation of APs.
Results:
Evidence indicating that negative and cognitive symptoms are present during the prodrome suggests that intervention at the time of first-episode psychosis constitutes late intervention. The limited efficacy of APs beyond psychosis argues against a magic bullet approach to schizophrenia and for polypharmacy that is symptom domain-specific. Clozapine's unique, but limited, efficacy in treatment resistance supports subtyping schizophrenia based on treatment response.
Conclusions:
Advances in our understanding of schizophrenia have important implications regarding the current use of APs, expectations regarding response, and future drug development.
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