Schizophrenia: Antipsychotics and drug development

Behav Brain Res. 2021 Sep 24:414:113507. doi: 10.1016/j.bbr.2021.113507. Epub 2021 Aug 3.

Abstract

The introduction of chlorpromazine and the work that ensued provided the foundation to reposition schizophrenia as a biological illness. The present paper follows the evolution of antipsychotics and their shift from 'typical' to 'atypical'. Atypicality is reviewed in reference to its original definition, clozapine's role, and developments that now leave the concept's utility in question. In a similar fashion, drug development is reviewed in the context of the illness' multiple symptom domains, as well as differences captured by clinical staging and phenotyping. Collectively, the evidence argues for a more nuanced approach to drug development that aligns with the illness' heterogeneity and complexity. Just as 'atypical' as a descriptor for antipsychotics may be outdated, it may be time to set aside the notion of developing drugs that treat 'schizophrenia'.

Keywords: Antipsychotics; Atypicality; Schizophrenia; Treatment.

Publication types

  • Historical Article
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Antipsychotic Agents / history*
  • Drug Development / history*
  • History, 20th Century
  • History, 21st Century
  • Humans
  • Schizophrenia / drug therapy*

Substances

  • Antipsychotic Agents

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