Antypsychotics in schizophrenia treatment - literature review

Aim. To analyze the administration of antipsychotics as main pharmaceuticals in treatment of schizophrenia as chronic mental disease involving several positive, negative, cognitive, and affective symptoms resulting in disorganization of mental activity and mental disadaptation in patients. Results. We have found the data on the absence of significant differences in efficacy of antipsychotics relative to positive symptoms and mental disorganization symptoms except for advantages of clozapine in the treatment of resistant cases. It shown that the therapy efficacy from the position of treatment of negative, depressive, and cognitive symptoms is determined depending on: (1) how the reduction of positive symptoms (delirium and hallucinations) improves the secondary symptoms of disease, and (2) how side extrapyramidal effects (EPSE) and side anticholinergic effects are corrected by drugs administered to influence EPSE aggravating the mentioned symptoms. There is a reasonable opinion that strong antipsychotics that do not have accompanying extrapyramidal actions and do not require the combined anticholinergic therapy have huge therapeutic advantages. Conclusion. It is found that having much in common in efficacy all antipsychotics greatly differ in rate and intensity of side effects. Contrary to belief that second-generation antipsychotics (so called atypical antipsychotics) are normally considered the drugs with less risk of extrapyramidal actions and higher risk of metabolic side effects in comparison with traditional antipsychotics; the significant variability of frequency of these and other side effects of these two types of drugs indicates that such categorical distinguishing of pharmaceuticals is not clinically justified. The choice of antipsychotic should be based on individual preferences of patients, their therapeutic response to the previous treatment, history of presence and specifics of antipsychotic side effects, medical data on risk factors, level of compliance to the prescribed treatment, and, especially, the profile of side effects of various antipsychotics.