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Academic Highlights: Challenges and Solutions in Developing New Medications for Schizophrenia

J Clin Psychiatry 2010;71(10):1391-1399
First page of Academic Highlights: Challenges and Solutions in Developing New Medications for Schizophrenia.

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Of the 24 million people with schizophrenia worldwide, fewer than half receive appropriate care. Even patients with access to the best available treatments suffer from significant functional and social deficits and multiple unmet needs. Fewer than one-third of treated patients are relatively symptom-free and functional. Even when treated, patients experience high rates of relapse and adherence problems and only minimal improvement in negative and cognitive symptoms, which are significant contributors to functional impairment. New medications for schizophrenia are needed that target different receptors/mechanisms of action. The focus has increasingly shifted toward developing an ideal “medication” for schizophrenia to not only reduce symptoms but also improve functioning and quality of life. Researchers developing such agents must overcome many challenges, including the need for novel designs to test agents with new mechanisms of action, new outcome measures to assess different symptomatic targets (eg, cognitive impairment), globalization, an increased focus on personalized medicine, and new diagnostic formulations coming in the DSM-5. The article concludes with an overview of the efficacy and safety of 4 recently introduced antipsychotics and agents under investigation—asenapine, iloperidone, lurasidone, and sertindole—to give clinicians a better understanding of the expanding treatment options available for patients with schizophrenia and the opportunity to find an agent that is best for each specific patient in terms of enhancing efficacy and minimizing side effects. The article concludes with practical guidance for clinicians on how to integrate new antipsychotics into their clinical practice to achieve best outcomes.