The pharmacological treatment of schizophrenia has made great strides in the last few decades. Many new drugs have been synthesized and commercialized, and these agents have notably improved the quality of life of many psychotic patients. Unfortunately, the aetiology of this disease is yet largely unknown, and the therapy is still symptomatic. Furthermore, a small percentage of patients do not respond to therapy, thus remaining outside the possibility of intervention of current medicinal practice. New developments in the field of antipsychotic drugs are a very interesting and topical subject in today's medicinal chemistry, from pharmacodynamic, pharmacokinetic, pharmacological and clinical point of view. First of all, the most recent perspectives for the design and development of innovative dopamine stabiliser agents will be presented. As reported in the first review, these compounds have the advantage of producing much less or none of those side effects that are a consequence of hypodopaminergia: they can thus alleviate abnormal motor and mental hyperactivity with only a slight risk of attaining activity levels below baseline. Next, the recent drugs already available on the market will be widely discussed in the following reviews of this issue, with special attention for the main atypical antipsychotics, such as clozapine, risperidone, olanzapine and quetiapine. We will focus on the advantages and importance of carrying out an accurate therapeutic drug monitoring (TDM) of schizophrenic patients undergoing pharmacologic therapy with atypical antipsychotics. The new pharmacogenomic-guided TDM, that will be presented in the third article, could complement and expand the scope of traditional TDM by providing a more complete portrayal of sources of variability in psychotropic drug response and will probably make important contributions to medical therapeutics in the future. New therapeutic strategies will be compared and discussed, such as polypharmacy with different antipsychotics or augmentation with drugs of other classes (e.g. antiepileptics). These practices are currently becoming more widely used. Nevertheless, experimental evidence at the basis of these practices is not unequivocal and the available literature on the subject will be critically reviewed. Finally, clinical data from both naturalistic and controlled studies regarding the efficacy and safety of atypical antipsychotics will be presented in the last two reviews. The naturalistic studies of second generation antipsychotics can provide information on the pattern of use, patient response, and tolerability of these recent drugs, and are useful tools because of the scarcity of long term comparative studies. The last article will focus on the advantages of atypical agents when compared to classical antipsychotics, and on the efficacy and side effects of the different new antipsychotics when compared to one another.
Pharmacological Treatment of Schizophrenia: Recent Antipsychotic Drugs and New Therapeutic Strategies
RAGGI, MARIA AUGUSTA
2004
Abstract
The pharmacological treatment of schizophrenia has made great strides in the last few decades. Many new drugs have been synthesized and commercialized, and these agents have notably improved the quality of life of many psychotic patients. Unfortunately, the aetiology of this disease is yet largely unknown, and the therapy is still symptomatic. Furthermore, a small percentage of patients do not respond to therapy, thus remaining outside the possibility of intervention of current medicinal practice. New developments in the field of antipsychotic drugs are a very interesting and topical subject in today's medicinal chemistry, from pharmacodynamic, pharmacokinetic, pharmacological and clinical point of view. First of all, the most recent perspectives for the design and development of innovative dopamine stabiliser agents will be presented. As reported in the first review, these compounds have the advantage of producing much less or none of those side effects that are a consequence of hypodopaminergia: they can thus alleviate abnormal motor and mental hyperactivity with only a slight risk of attaining activity levels below baseline. Next, the recent drugs already available on the market will be widely discussed in the following reviews of this issue, with special attention for the main atypical antipsychotics, such as clozapine, risperidone, olanzapine and quetiapine. We will focus on the advantages and importance of carrying out an accurate therapeutic drug monitoring (TDM) of schizophrenic patients undergoing pharmacologic therapy with atypical antipsychotics. The new pharmacogenomic-guided TDM, that will be presented in the third article, could complement and expand the scope of traditional TDM by providing a more complete portrayal of sources of variability in psychotropic drug response and will probably make important contributions to medical therapeutics in the future. New therapeutic strategies will be compared and discussed, such as polypharmacy with different antipsychotics or augmentation with drugs of other classes (e.g. antiepileptics). These practices are currently becoming more widely used. Nevertheless, experimental evidence at the basis of these practices is not unequivocal and the available literature on the subject will be critically reviewed. Finally, clinical data from both naturalistic and controlled studies regarding the efficacy and safety of atypical antipsychotics will be presented in the last two reviews. The naturalistic studies of second generation antipsychotics can provide information on the pattern of use, patient response, and tolerability of these recent drugs, and are useful tools because of the scarcity of long term comparative studies. The last article will focus on the advantages of atypical agents when compared to classical antipsychotics, and on the efficacy and side effects of the different new antipsychotics when compared to one another.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
