Literature Reviewed

The Pharmacologic Treatment of Schizophrenia 2021 by DC Goff. JAMA. 2021;325(2):175-176.

Original Introduction

Schizophrenia is a chronic psychotic disorder with typical onset in early adulthood and a lifetime prevalence of approximately 1%. In addition to the hallmark symptoms of psychosis (delusions, hallucinations, disordered thinking), individuals may experience negative symptoms (apathy, loss of emotional expression) and cognitive deficits. In the past, people with schizophrenia often were confined life-long to psychiatric hospitals; however, the introduction of effective antipsychotic drugs, starting with chlorpromazine (Thorazine) in 1954, followed by the federal Community Mental Health Act of 1963 resulted in deinstitutionalization of an estimated 92% of hospitalized patients by 1994. Although outpatient treatment has been largely successful in allowing people with schizophrenia to live in the community, a shortage of treatment and rehabilitation services and housing, combined with reluctance of some to accept services, has contributed to high rates of homelessness and incarceration among those with schizophrenia in the US.

Read the full paper.

Schizophrenia Early Intervention: Commentary and Clinical Takeaways

A clinical overview published in the Journal of the American Medical Association earlier this year by Donald Goff, a psychiatrist at New York University (NYU) Langone, reviews the current pharmacological treatment for patients with schizophrenia. When treating patients with schizophrenia, “delay in initiating treatment has been associated with poor outcomes,”1 wrote Goff. Withholding effective treatment may prolong the risks associated with psychosis and worsen long-term outcomes. It is important to begin therapy in the early stages of disease progress, or the “prodromal” stage, to reduce both positive and negative symptoms and allow patients to function independently.1

Antipsychotics for the Treatment of Schizophrenia

Antipsychotic medications including FGAs and SGAs are regarded as the first-line recommendation. FGA’s mechanisms of action share dopamine D2 antagonism and are associated with side effect profiles that include parkinsonism, akathisia, tardive dyskinesia and hyperprolactinemia.1 With this unfavorable side effect profile from FGAs, SGA medications were created. While both are effective in treating symptoms of schizophrenia, SGAs have reduced neurologic adverse effects but increased metabolic side effects such as weight gain and insulin resistance compared to FGAs.1

There are currently 10 SGAs available in the United States that provide similar efficacy but “differ meaningfully in adverse effect profiles.”1 There are also long-acting injectable antipsychotic (LAIA) options in each class that are available and assist in improving patient adherence. Psychosocial interventions such as cognitive behavioral therapy (CBT), family psychoeducation, and social skills training can also be considered for patients with schizophrenia to assist with negative symptoms and cognitive deficits.1 The use of these interventions helps equip patients and their families and caregivers with resources and social skills to better manage their mental illness.

To treat individuals diagnosed with schizophrenia, we can glean from this article that it is important to provide early interventions with both medications and psychosocial treatments to improve clinical outcomes and set patients as well as their families up for success in preventing relapse or worsening symptoms.

Next Paper in the Literature Review: Atypical Antipsychotics and Metabolic Syndrome: From Molecular Mechanisms to Clinical Differences by Carli M, Kolachalam S, Longoni B, et al. Pharmaceuticals (Basel). 2021.

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Last Updated: Sep 1, 2021