Schizophrenia - Treatment Principles

Schizophrenia is a chronic mental health condition that requires long-term treatment throughout the course of illness. Treatment aims to reduce symptoms, prevent relapse, and improve functioning and quality of life. Although antipsychotic medications remain the foundation of treatment, many individuals do not achieve an adequate response to their first prescribed medication, and some develop treatment-resistant schizophrenia. Persistent negative and cognitive symptoms also continue to present significant challenges and contribute to poor functional outcomes, highlighting the need for comprehensive treatment strategies and the development of new therapeutic approaches. In this slide deck, the principles of treatment in schizophrenia are reviewed, including treatment goals, the management of acute episodes, the classification of antipsychotic drugs, and approaches to inadequate response to first-line treatment. It also covers steps to rule out pseudo non-response, the management of negative and cognitive symptoms, maintenance treatment, and emerging therapies that may improve outcomes for people living with schizophrenia.

This slide deck was developed by Professor Dr. Stefan Leucht, Department of Psychiatry and Psychotherapy, Technical University of Munich, Germany; and Professor Dr. Christoph Correll, Charité – Universitätsmedizin Berlin, Germany, in collaboration with Cambridge (a division of Prime, Cambridge, UK).

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Index for
slide deck

Introduction

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Treatment goals in schizophrenia

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Different phases of schizophrenia have different treatment goals

References:

1. Lehman AF, Lieberman JA, Dixon LB, et al. Practice guideline for the treatment of patients with schizophrenia, second edition. Am J Psychiatry 2004; 161 (2 Suppl): 1–56.

2. Leucht S, Siafis S, McGrath JJ, et al. Schizophrenia. Nat Rev Dis Primers 2025; 11: …

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Classification of antipsychotic drugs

The neuroscience-based nomenclature (NbN) approach:¹

Integrates contemporary advances in neuroscience
Informs clinical decision-making about prescribing
Facilitates patient understanding of their prescription and enhances adherence
Accommodates the inclusion of new types…

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Criteria for antipsychotic drug choice

The Section For Evidence-Based Medicine in Psychiatry & Psychotherapy website provides useful tools for determining appropriate antipsychotics doses.

Dose calculator websites:

The Section For Evidence-Based Medicine in Psychiatry & Psychotherapy, https://ebmpp.org/helpfu…

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Antipsychotic dosing in the acute phase

References:

1. Leucht S, Crippa A, Siafis S, et al. Dose-response meta-analysis of antipsychotic drugs for acute schizophrenia. Am J Psychiatry 2020; 177: 342–353.

2. Leucht S, Bauer S, Siafis S, et al. Examination of dosing of antipsychotic drugs for relapse prevention i…

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Efficacy and side effects of major antipsychotic drugs (I)

Data from randomized controlled trials that enrolled patients with acute psychotic symptoms of schizophrenia were used to assess efficacy and tolerability outcomes for 23 primarily dopamine-receptor blocking antipsychotics and the muscarinic receptor agonist xanomeline–tr…

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Efficacy and side effects of major antipsychotic drugs (II)

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A tool for the acute treatment of schizophrenia

Illuminatum is a resource described as a “Living Information Center”, which was founded by the Section for Evidence-Based Medicine in Psychiatry and Psychotherapy at the Technical University of Munich. The aim of Illuminatum is to provide a source of evidence-based inform…

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