Critical issues in the treatment of schizophrenia

Treatments that effectively control schizophrenia are now available. The full benefits of these treatments, however, are not being realized, as a result of insufficient compliance by patients and doctors. Patient noncompliance has been largely the result of the shortcomings of conventional antipsychotics (e.g. subjectively distressing side effects), their inappropriate application (e.g. excessively high dosages) and the lack of patient insight into or information about schizophrenia and its treatment. The development of guidelines for drug treatment, the introduction of novel antipsychotics with a better risk-benefit ratio and the implementation of psychosocial interventions all help to improve compliance and treatment outcome. Continued effort needs to be directed towards the educational programmes that have been developed, to ensure that they are used to their maximum potential. Critical treatment issues in the different phases of schizophrenia have been outlined.