Treatment challenges in schizophrenia

The current level of innovation in psychopharmacology in the treatment of schizophrenia generates as many challenges as it solves problems. A reorientation of practice, in particular around the establishment of a strong doctor-patient relationship to promote and support medication compliance, is required to incorporate the newer drugs successfully into the care of schizophrenia and achieve their potential. The recent satellite symposium, sponsored by Zeneca Pharmaceuticals, explored the major forces shaping these developments. The differences between atypical and typical antipsychotics were examined, in particular the hypothesis that there may be two discrete types of atypical. One group of atypicals masks its extrapyramidal symptoms (EPS) and the other (clozapine and quietapine) may simply not stimulate EPS. The underestimation of the frequency of EPS by psychiatrists was dramatically demonstrated in the symposium with the use of keypad questions and answers. A novel approach to the significance of EPS was presented using a public health perspective, thereby challenging the common notion that maximum benefit would be obtained by restricting atypicals to high risk groups. We have the rare opportunity of some primary prevention in mental health care. As the clinical risk of EPS is reduced with atypicals other side-effects require consideration and sexual dysfunction and the role of prolactin is presented. Again keypad questions demonstrated the inaccuracy of clinicians' estimates of prevalence. The symposium drew these strands together by emphasizing the central role of communication in building a collaborative therapeutic alliance in the care of patients with schizophrenia.