The role of psychopharmacotherapy in improving the long-term outcome of schizophrenia.

Drs. Alam and Janicak briefly review the current indications and problems associated with the use of atypical antipsychotics in schizophrenia treatment. When called for, they may be augmented by mood stabilizers, such as lithium; antidepressants; benzodiazepines (for rapid tranquillization during agitated psychotic episodes); and stimulants, even nicotine, to improve cognition. Even though extrapyramidal side effects are less frequent and less intense that those seen with traditional antipsychotics, they do occur; the authors spell out the attributes of those patients who are most vulnerable. Clinicians should also look for weight gain and the risk of activating or aggravating type 2 diabetes in patients, as well as cardiac risk involving prolongation of the QTc interval. Because, despite of modern approaches to treatment, 80% of patients end up rehospitalized and only 1 in 3 can be said to have a good level of socialization, active measures must be taken to ensure continuity of care, monitoring for prodromal symptoms, early intervention, and psychosocial rehabilitation.