Schizophrenia

Overview

Schizophrenia is a complex syndrome characterised by three major symptom domains: positive symptoms, such as auditory hallucinations, delusions, and thought disorder; negative symptoms, including anhedonia, social withdrawal, affective flattening, and demotivation; and cognitive dysfunction, particularly in the domains of attention, working memory, and executive function.[1] Schizophrenia is typically a life-long condition characterised by acute symptom exacerbations and widely varying degrees of functional disability. Maintenance antipsychotic drug regimens for schizophrenia are intended to limit the frequency and severity of relapses, maximise the beneficial effects of treatment for persistent symptoms, and enhance adherence to recommended regimens. Antipsychotic medications are primarily effective for positive symptoms, and most people require psychosocial interventions to manage the disability that often results from negative symptoms and cognitive dysfunction.[2] Adherence to prescribed antipsychotic regimens is typically low, and several psychosocial interventions have been developed to enhance adherence. About 20% of people with schizophrenia are resistant to standard antipsychotics, as defined by lack of clinically important improvement in symptoms after two to three regimens of treatment with standard antipsychotic drugs for at least 6 weeks; an additional 30% to 40% of people improve but are residually symptomatic despite antipsychotic treatment.[3] Several pharmacological strategies have been advocated for this group of people. This review focuses on three key aspects of the management of schizophrenia: 1) What are the effects of drug treatments for positive, negative, or cognitive symptoms of schizophrenia? 2) What are the effects of interventions in people with schizophrenia who are resistant to standard antipsychotic drugs? and 3) What are the effects of interventions to improve adherence to antipsychotic medication in people with schizophrenia?