Pharmacotherapy of Schizophrenia

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Abstract
Schizophrenia is a disorder of the brain with multicausality, chronicity, and various symptom manifestations within its course. The therapeutic interventions are determined by the actual psychiatric condition characterized by the three main syndromes (positive, negative and cognitive symptoms). Antipsychotics are essential drugs in the therapy of schizophrenia and anxiolytics, antidepressants, antiepileptics are only adjuvants with temporary use. The previous studies show no results in the therapy of the cognitive symptoms, and the new antipsychotics improve the negative symptoms moderately. The reduction and prevention of positive symptoms is practicable with the established selection of antipsychotics. The antipsychotics are the basis therapy of schizophrenia so the knowledge of their pharmacology and clinical effects are essential for the clinicians. The typical-atypical classification is an outworn concept because there are pharmacological differences not only between the two groups but within the groups too. There are no significant differences among the antipsychotics with respect to efficiency but their side effect profiles are very different. The choice of a drug is influenced by the actual psychic and somatic conditions, comorbidity on one hand, and on the other hand by the pharmacodynamic and pharmacokinetic characteristics of the drugs. For example an antipsychotic with high affinity to dopamine receptors would be the good choice to eliminate the psychotic syndrome, but another one with low risk to cause extrapyramidal side effects would be the right choice for long term therapy. The next important question is the adjustment of the dose which is determined by the patient's somatic conditions and pharmacological factors, such as absorption, activity of metabolizing enzymes, function of the blood-brain barrier. In the lack of this property the clinicians can optimalize the dose only with the evaluation of the clinical response. The switch of a drug is required if it is ineffective or causes side effects. In these cases the clinicians have to be familiar with the pharmacological features of the two drugs and the condition of the patient. In the course of schizophrenia you can experience depressive, anxious, aggressive states that can be treated with adjuvants, but the risk/benefit ratio of these therapies should be considered. In addition to the drug administration the patients need psychological intervention and/or social therapy, however that cannot work without effectively tailored pharmacotherapy. Important viewpoints are the patient's well-being and the level of his functionality, that also depends on the right drug therapy. The aim of the author was to help clinicians in their decision making.

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