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Newer Treatments for Schizophrenia: Benefits and Drawbacks

(PSYCHIATRIC TIMES) - New treatments for patients with schizophrenia may be on the horizon, according to research presented at the annual meeting of the American Psychiatric Association (APA) in San Francisco.1 While some of these therapies may help treat the negative and cognitive symptoms of schizophrenia, a few are associated with QTc interval prolongation.

Although about 70% of patients with schizophrenia in the United States are treated with more than 1 therapy, fewer than a third are symptom-free and able to function, according to Adrian Preda, MD, associate professor of psychiatry and human behavior at the University of California, Irvine.

Steven Potkin, MD, professor of psychiatry at the University of California, Irvine, discussed 4 of the newest compounds that have either been recently approved for the treatment of schizophrenia or are in late-stage development. Each has been demonstrated to have no effect on weight gain or increases in lipid levels, he said.

The FDA recently approved iloperidone for the treatment of schizophrenia. However, this is considered to be a second- or third-line drug because patients treated with this drug have been shown to experience QTc interval prolongation, said Dr Potkin.

The benefit of this therapy is that physicians can determine who may best respond. Studies have identified 6 genetic markers that are associated with iloperidone effectiveness and safety. Patients with 0 to 2 markers have approximately a 15% clinical response to iloperidone treatment. Those with 3 markers have approximately a 40% likelihood of improvement, and those with 4 markersare approximately 60% likely to improve. Almost all patients with 5 or 6 markers were shown to respond to treatment. “Even if you don’t know anything about a patient, there is still about a 48% chance of a clinical response to treatment, according to Potkin.

Results from recent trials of treatment of acute psychotic exacerbation in patients with schizophrenia showed that iloperidone was more effective than placebo and comparable to risperidone.2 In addition, the effects of iloperidone were similar to those of haloperidol in reducing symptoms of schizophrenia.3

Studies have shown that lurasidone may be appropriate for the treatment of cognitive impairment and depressive symptoms in patients with schizophrenia. Results of phase 3 clinical trials on treatment of schizophrenia were presented at the APA conference. In a 6-week, double-blind, placebo-controlled trial, patient symptoms were assessed using the Brief Psychiatric Rating Scale (BPRSd). Patients treated with lurasidone 80 mg daily had significant improvement compared with those who received placebo, based on results using the BPRSd (-8.9 vs -4.2; P = .012).4

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