New Targets for the Management of Schizophrenia

Schizophrenia is characterized by abnormal mental functions and disturbed behavior. The diagnosis of schizophrenia is based on criteria defined in either the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, version DSM-IV (2) or the ICD-10. Targets of treatment include positive and negative symptoms, depression, suicidal ideation and behaviors, substance use disorders, medical comorbidities, posttraumatic stress disorder, and community adjustment problems. The first-generation antipsychotics were first introduced for the treatment of schizophrenia in the 1950s. The introduction of second-generation antipsychotics (SGAs) in the last three decades improved the desired effects of these medications with a reduction of their undesirable effects such as extrapyramidal adverse effects, mortality and metabolic disorder. Medication is generally helpful in treating positive symptoms, but up to a third of people derive little benefit, and negative symptoms are difficult to treat. It has been shown that lack of efficacy and tolerability, often associated with poor compliance, results in treatment discontinuation or treatment switch. Despite critical importance of medication for patients with schizophrenia, nonadherence to treatment is an important issue worldwide. The most prominent patient-related factors associated with nonadherence included lack of insight into the need for medication, denial of illness, embarrassment and unsuitable living conditions. Although antipsychotic medications are necessary, they are not sufficient for the treatment of schizophrenia. The cognitive therapy (cognitive behavioral therapy and cognitive remediation therapy), social skills, psychoeducation programs, family intervention, training programs, and case management or assertive community treatment are the major categories of psychosocial intervention which is an important part of the disease management. The major considerations in disease management treatment include the comprehensive and continuous treatment for prolonged periods, integrated, biopsychosocial approach to care, active collaboration with the family while planning and delivering treatment and treatment sensitive to the patient’s needs and empirically titrated to the patient’s response and progress.