Objectives: This article are to describe current trends in the treatment of schizophrenia and
the most interesting new approaches to optimizing outcome and fostering the development of new
Results: Increasing utilization of diverse types of atypical antipsychotic drugs (AAPDs), e.g. clozapine-
type serotonin (5-HT)2A and weak dopamine (DA) D2 antagonist, amisulpride, a D2/D3/5-HT7 antagonist,
and cariprazine, a D3 partial agonist with additional neurotransmitter targets, is occurring as
their advantages in efficacy, especially for cognitive impairment and mood symptoms, and side effects
are becoming appreciated. Typical APDs, e.g. haloperidol, are diminishing in favor because of their
EPS, especially, tardive dyskinesia (T D) and appreciation that reducing D2 receptor stimulation is not
the only means to treat psychosis. Some of the mechanisms inherent in various AAPDs, e.g. 5-HT2A
inverse agonism, and D3 receptor partial agonism, are now recognized as effective treatments for psychosis.
A new focus on treating the cognitive impairment associated with schizophrenia (CIAS) has
emerged via mechanisms such as stimulation of acetyldraline receptor with muscarinic and nicotinic
receptor agonists, but demonstrating their efficacy in trials is proving elusive. Pharmacogenetic strategies
which may lead to personalized treatment of schizophrenia are emerging but have not yet succeeded
in being widely reimbursable. Transcranial stimulation and cognitive enhancement therapy are
more common but more evidence for their efficacy is needed.
Conclusion: The heterogeneity of the pathophysiology of the various domains of schizophrenia requires
a diversity of treatments that are best met by the expert use of AAPDs at the current time.
Pharmacogenetic efforts are consistent with new evidence that multiple genes are involved in the risk
for schizophrenia and the effectiveness of AAPDs.