An appraisal of the major Guidelines on the pharmacotherapy of schizophrenia

Una valutazione ragionata delle principali linee guida internazionali sulla farmacoterapia della schizofrenia

G. Muscettola, A. Rossi, S. Scarone


This review focuses on a comparative analysis on international Guidelines for the treatment of schizophrenia and, more generally, on specific literature, starting from the 2004 APA Guidelines. The first issue taken into consideration is treatment: general purpose of drug treatment is generally distinguished from specific target as well as needs of specific therapeutic practices are distinguished from theoretical aspects of optimal treatment. Guidelines refer to a global reduction in symptoms, primarily in terms of potential clinical recovery. The complexity of schizophrenia implies the need to consider different options for treatment due to the clinical phase of the disorder and other critical factors. The choice of drug treatment is thus considered as a priority in the acute phase of schizophrenia and should be considered as continuous and possibly indefinite, if the response is inadequate or there are frequent relapses over time. The definition of clinical phases of schizophrenia is linked to the chosen reference. The analysis then focuses on the pharmacological treatment of schizophrenia in its various phases, with particular reference to similarities/differences and limitations of the Guidelines. The impression given by a comparative reading of the Guidelines taken into consideration, is that of a general separation between indications for pharmacological management of schizophrenia and clinical practice, both in the acute and chronic phase. Authors then examine the general recommendations to specific drugs focusing particularly on the relationship between first and second generation antipsychotics, with an analysis of comparative efficacy and special considerations (eg, negative symptoms, cognitive symptoms, resistance); recommendations regarding antipsychotic therapy in schizophrenia and early-onset time and duration and treatment strategies are also described and commented.

Particular attention is devoted to side effects and monitoring of physical health, both in terms of neurological effects (Tables II-III) and of effects on sexual (Table IV) and hepatic function. Much space is devoted to emerging issues such as metabolic syndrome, obesity, dyslipidemia, diabetes (Tables VI) and cardiovascular risk (Table VII) with emphasis on the growing awareness that many side effects, especially metabolic ones, require particular care with a multidisciplinary approach.

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