Future treatment of schizophrenia.

In spite of 35 years of experience with antipsychotic drugs, the psychiatrists are still faced with the limitations of these drugs: no or minimal therapeutic effect in hallucinations and delusions in about 25% of schizophrenic patients; persisting anergia and emotional withdrawal in otherwise successfully treated patients; a great spectrum of side effects, some irreversible. Quo vadis? An incidental discovery of a completely new drug, a new "chlorpromazine" would be the ideal solution, but for the present, one has to continue with the small pragmatic steps, especially within the following areas: (a) the selective antidopaminergic drugs, especially the substituted benzamides, may be further developed in the direction of antipsychotic selectivity with fewer and fewer extrapyramidal side effects; (b) the atypical clozapine ought soon to have successors, hopefully without the risk of bone marrow depression and cardiovascular side effects; (c) the D1 antagonists as well as the D1 agonists may imply therapeutically valuable effects; (d) the dopamine autoreceptor has long been in focus, but until now, no pure agonist has been found, and the drugs available, including (-)3-PPP, appear to have many side effects; (e) serotonin antagonists may be an interesting possibility; and (f) when it may be possible to influence brain peptides more efficiently than up to now, this area will probably provide us with several psychotropic drugs. Furthermore, during the search for new antipsychotic drugs, one must not forget to improve the practical use of available neuroleptics and of nonpharmacological, psychosocial treatment modalities.