Pharmacologic Treatment Of Schizophrenia

A handbook for treating schizophrenia with antipsychotic drugs includes coverage of continuation and maintenance therapy and patient outcomes and economic evaluation data.

This manual attempts to provide simple, adequate and evidence-based information to health care professionals in primary health care especially in low- and middle-income countries to be able to provide pharmacological treatment to persons with mental disorders. The manual contains basic principles of prescribing followed by chapters on medicines used in psychotic disorders; depressive disorders; bipolar disorders; generalized anxiety and sleep disorders; obsessive compulsive disorders and panic attacks; and alcohol and opioid dependence. The annexes provide information on evidence retrieval, assessment and synthesis and the peer view process.

The new edition of this popular handbook has been thoroughly updated to include the latest data concerning treatment of first-episode patients. Drawing from their experience, the authors discuss the presentation and assessment of the first psychotic episode and review the appropriate use of antipsychotic agents and psychosocial approaches in effective management. This is an authoritative text written by a team of highly respected authors for psychiatrists, neurologists, primary care practitioners and health care professional working in psychiatry. Drawing from their experience, the presentation and assessment of the first psychotic episode are discussed, details regarding antipsychotic drugs and their appropriate use are reviewed and psychosocial approaches are examined. The resulting book offers a concise and valuable guide to those wishing to review the latest proposals for the treatment of first-episode psychosis supported by up-to-date references, in a single publication.

Six decades after the serendipitous discovery of chlorpromazine as an antipsychotic and four decades after the launch of clozapine, the first atypical or second generation antipsychotic, psychopharmacology has arrived at an important crossroad. It is clear that pharmacological research and pharmaceutical development must now focus on complementary or even alternative mechanisms of action to address unmet medical needs, i.e. poorly treated domains of schizophrenia, improved acceptance by patients, better adherence to medication, safety in psychoses in demented patients, and avoiding cardiac and metabolic adverse effects. The first completely novel mechanisms evolving from our insights into the pathophysiology of psychotic disorders, especially the role of glutamatergic mechanisms in schizophrenia, are now under development, and further principles are on the horizon. This situation, in many respects similar to that when the initial second-generation antipsychotics became available, can be rewarding for all. Preclinical and clinical researchers now have the opportunity to confirm their hypotheses and the pharmaceutical industry may be able to develop really novel classes of therapeutics. When we were approached by the publishers of the Handbook of Experimental Pharmacology to prepare a new volume on antipsychotics, our intention was to capture both, the accumulated preclinical and clinical knowledge about current antipsychotics as well as prospects for new and potentially more specific antischizophrenia principles. These efforts should be based on the pathophysiology of the diseases and the affected neurotransmitter systems. Since preclinical research on antipsychotic compounds is only reliable when intimately linked through translational aspects to clinical results, we decided to include clinical science as well. It turned out that that this endeavor could not be covered by a single volume. We thank the editorial board and the publishers for supporting our decision to prepare two volumes: Current Antipsychotics and Novel Antischizophrenia Treatments. These topics cannot really be separated from one another and should be seen as a composite entity despite the somewhat arbitrary separation of contributions into two volumes. The continuing challenges of developing improved and safer antipsychotic medications remain of concern and are discussed in the first volume. The new opportunities for the field to develop and license adjunctive treatments for the negative symptoms and cognitive deficits that are treated inadequately by existing compounds have been incentivized recently and provide the focus for the second volume. We hope these collective contributions will facilitate the development of improved treatments for the full range of symptomatology seen in the group of schizophrenias and other major psychotic disorders. Gerhard Gross, Ludwigshafen, Germany Mark A. Geyer, La Jolla, CA This volume will try to put current therapy - achievements, shortcomings, remaining medical needs - and emerging new targets into the context of increasing knowledge regarding the genetic and neurodevelopmental contributions to the pathophysiology of schizophrenia. Some of the chapters will also deal with respective experimental and clinical methodology, biomarkers, and translational aspects of drug development. Non-schizophrenia indications will be covered to some extent, but not exhaustively.

The introduction of antipsychotic agents in the 1950’s substantially improved the treatment of schizophrenia and other psychotic disorders. However, clinical and functional outcomes are still far less than optimal for patients, and have not improved in recent years despite the development of several new antipsychotics. Efficacy rates are further compromised by medication non-adherence, which has been reported to affect more than half of patients. In response to these issues, several non-pharmacological interventions have been developed for the treatment of schizophrenia, such as cognitive behavioral therapy, cognitive remediation, social cognition training and metacognitive approaches. Although these interventions have produced promising results, there is still much controversy regarding their usefulness and applicability in clinical practice. A major impeding factor for their dissemination is possibly a lack of sufficient evidence regarding their specific indications, mechanisms of action, adverse effects, but also practical issues concerning the interpretability of respective clinical studies, such as the choice of outcome variables and control of confounding factors. The present Research Topic includes original research articles and reviews addressing these issues.