Page 297 - merged

State of the Art 8

Treatment Options in Schizophrenia: Bridging Unmet Needs and New
Findings

Prof. Dr. Peter Falkai

Chairman, Department of Psychiatry and Psychotherapy, University of Munich

The treatment of schizophrenia is multidimensional and includes pharmacotherapy,
psychotherapy and socio-therapy as its main columns. Since the introduction of antipsychotics
the treatment options of schizophrenia have improved considerably, however, still leaving
behind about 20% of the patients non-remitting and about 30-40% of multi-episode patients
showing partial remission with residual symptoms. A thoughtful systematic combination of
evidence-based pharmacotherapy (when to give what, how and how much), psychotherapy
and socio-therapy is needed to reduce the number of partial remissions and non-remissions.
Introducing clozapine early in the treatment of partial or non-remission is one major step
accompanied by a systemic inclusion of schizophrenia patients into group psychotherapy
(psychoeducation, cognitive behavioural therapy (CBT)) to reduce the extent of residual
symptoms.

A completely new path of treatment options arise with adding stimulation methods
(rTMS, tDCS) for improving brain plasticity, leading to better remission qualities. Beside a
systematic use of all treatment options it is necessary to keep major side effects (such as
weight gain, sedation, sexual dysfunction and metabolic syndromes) in mind. Using
pharmacological options to stop weight gain (e.g. Topriamat) need to be combined with
psychoeducation on a healthy diet and exercise.
Taken together, evidence based therapy of schizophrenia comprises a lot of options to
improve the outcome of this illness. A thoughtful combination of already present options as a
first step followed by new developments as the second step seems the way to go forward.