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Review
. 2015 Mar;60(3 Suppl 2):S14-8.

What does schizophrenia teach us about antipsychotics?

Gary Remington  1 , Ofer Agid  2 , George Foussias  3 , Gagan Fervaha  4 , Hiroyoshi Takeuchi  5 , Jimmy Lee  6 , Margaret Hahn  3
Affiliations
Review

What does schizophrenia teach us about antipsychotics?

Gary Remington et al. Can J Psychiatry. 2015 Mar.

Abstract
in English, French

Objective: To examine how advances in our understanding of schizophrenia have shaped thinking about antipsychotics (APs) and their role in treatment.

Method: Three specific developments in the field of schizophrenia are highlighted: advances in knowledge related to the earliest stages of schizophrenia, specifically the prodrome; reconceptualization of schizophrenia as an illness of multiple symptom domains; and greater clarification regarding the efficacy of clozapine and a new generation of APs.

Results: Evidence indicating that negative and cognitive symptoms are present during the prodrome suggests that intervention at the time of first-episode psychosis constitutes late intervention. The limited efficacy of APs beyond psychosis argues against a magic bullet approach to schizophrenia and for polypharmacy that is symptom domain-specific. Clozapine's unique, but limited, efficacy in treatment resistance supports subtyping schizophrenia based on treatment response.

Conclusions: Advances in our understanding of schizophrenia have important implications regarding the current use of APs, expectations regarding response, and future drug development.

Objectif :: Examiner comment les progrès de notre compréhension de la schizophrénie ont formé notre idée sur les antipsychotiques (AP) et leur rôle dans le traitement.

Méthode :: Trois développements spécifiques du domaine de la schizophrénie sont présentés : le progrès des connaissances relatives aux stades précoces de la schizophrénie, spécialement le prodrome; la reconceptualisation de la schizophrénie comme étant une maladie de multiples domaines de symptômes; et une clarification accrue concernant l’efficacité de la clozapine et d’une nouvelle génération d’AP.

Résultats :: Les données probantes indiquant que des symptômes négatifs et cognitifs sont présents durant le prodrome suggèrent que l’intervention au moment du premier épisode psychotique constitue une intervention tardive. L’efficacité limitée des AP au-delà de la psychose est un argument défavorable à une approche de solution magique pour la schizophrénie, et en faveur de la polypharmacie qui est propre au domaine de symptômes. L’efficacité unique mais limitée de la clozapine dans la résistance au traitement soutient le soustypage de la schizophrénie selon la réponse au traitement.

Conclusions :: Les progrès de notre compréhension de la schizophrénie ont d’importantes implications pour l’utilisation actuelle des AP, les attentes quant à la réponse, et le développement pharmaceutique futur.

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References

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