Antipsychotic Treatment Strategies in Schizophrenia
Summary
Schizophrenia is a chronic and heterogeneous psychiatric disorder characterised by positive symptoms such as hallucinations and delusions, negative symptoms including social withdrawal and affective blunting, and cognitive impairment. Antipsychotic medications form the mainstay of treatment and are broadly classified into first-generation (typical) and second-generation (atypical) agents, distinguished by their receptor profiles and side-effect burden. Current strategies emphasise individualised selection of agents to balance efficacy against side effects such as metabolic dysregulation and extrapyramidal symptoms, with clozapine reserved for treatment-resistant cases. Dose optimisation and long-acting injectable formulations have improved adherence and reduced relapse rates, while combination approaches are considered for subgroups with incomplete response. Emerging paradigms integrate digital tools and biomarkers to personalise prescribing, refine dosing based on dopamine D2 receptor occupancy, and predict adverse-effect risk. A holistic model incorporating psychosocial interventions, non-pharmacological therapies and shared decision making underpins modern antipsychotic treatment, with the aim of maximising functional recovery and quality of life.
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Antipsychotic Treatment Strategies in Schizophrenia publication trend
The graph below shows the total number of articles in antipsychotic treatment strategies in schizophrenia across all publications each year (not limited to Nature Index journals).
Technical terms
Dopamine D2 receptor occupancy: The proportion of striatal D2 receptors bound by an antipsychotic, correlating with both therapeutic effects and risk of motor side-effects.
Extrapyramidal side-effects (EPS): Drug-induced movement disorders including akathisia, parkinsonism and dystonia, typically arising from dopamine blockade in the nigrostriatal pathway.
Polypharmacy: The use of two or more antipsychotic agents concurrently, often employed when monotherapy yields inadequate symptom control.
Monotherapy: Treatment with a single antipsychotic agent, generally preferred to minimise pharmacodynamic interactions and cumulative side-effect burden.
Long-acting injectable antipsychotics (LAIs): Depot formulations administered at extended intervals to improve adherence and reduce relapse in schizophrenia.
References
- Antidepressant and antipsychotic side-effects and personalised prescribing: a systematic review and digital tool development. The Lancet Psychiatry (2023).
- Antipsychotic dose, dopamine D2 receptor occupancy and extrapyramidal side-effects: a systematic review and dose-response meta-analysis. Molecular Psychiatry (2023).
- Experiences of reduction and discontinuation of antipsychotics: a qualitative investigation within the RADAR trial. EClinicalMedicine (2023).
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