Algorithm for schizophrenia in Japan

An algorithm for schizophrenia and related psychotic disorders based on current Japanese trends in pharmacotherapy is proposed. In practice, selection of anti-psychotics takes into account additional variables: acute and long-term side effects, inter- and intra-individual variation in efficacy, clinical response to any previously administered antipsychotics, and information on blood levels where clinical relevance is known. Besides pharmacotherapy, various psychosocial therapies are also required, especially for treating the secondary functional and interpersonal handicaps that result from the long-term expression of the illness. It should be noted that clozapine is not included in the algorithm since concerns about its cytotoxic effects have prevented its introduction in Japan. Additionally, risperidone is still under clinical evaluation in Japan, and its relative utility remains to be established.