Psychopharmacologic treatment of schizophrenia

Antipsychotic (neuroleptic) medications continue to be a critical component in the treatment of schizophrenia. Despite numerous advances in brain imaging, genetics, and neurochemistry, the pharmacologic agents routinely used to treat schizophrenia have not changed markedly over the last 30 years. The introduction of clozapine, however, represents an important step in drug development and has stimulated renewed activity in this area. In addition, its novel effects have had a heuristic value in efforts to better understand neuropharmacologic mechanisms. While we await further advances in treatment development, we are benefiting from clinical research focusing on improving our ability to use available pharmacotherapy in the most effective and least toxic manner. Recent studies reemphasize the potential value of using the minimum effective dosage for acute treatment (e.g., 10-15 mg/day of oral haloperidol) and provide needed data on the benefits and risks of long-term dosage reduction strategies (i.e., continuous low-dose or targeted/intermittent treatment).