What does schizophrenia teach us about antipsychotics?

Gary Remington, Ofer Agid, George Foussias, Gagan Fervaha, Hiroyoshi Takeuchi, Jimmy Lee, Margaret Hahn

Canadian journal of psychiatry. Revue canadienne de psychiatrie 2015 Mar

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To examine how advances in our understanding of schizophrenia have shaped thinking about antipsychotics (APs) and their role in treatment. 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. 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. Advances in our understanding of schizophrenia have important implications regarding the current use of APs, expectations regarding response, and future drug development.

Citation

Gary Remington, Ofer Agid, George Foussias, Gagan Fervaha, Hiroyoshi Takeuchi, Jimmy Lee, Margaret Hahn. What does schizophrenia teach us about antipsychotics? Canadian journal of psychiatry. Revue canadienne de psychiatrie. 2015 Mar;60(3 Suppl 2):S14-8