Psychiatria pre prax 4/2020

Antipsychotics in the treatment of predominant negative symptoms in schizophrenia - What are the updated guidelines telling us?

Notwithstanding our expanding knowledge of negative symptoms of schizophrenia, there was a lack of treatment options targeting its entire phenotype, including affective flattening, alogia, avolition, anhedonia, and asociality. All currently licensed medication for symptoms of schizophrenia act predominantly through dopaminergic modulation, mostly targeting positive symptoms, behavioral disturbances and aggressiveness. In contrast, the functionally relevant domains of negative and cognitive symptoms remain relatively unaffected. Results from the research together with bottom facts from the review papers suggest that second-generation antipsychotic medication, like cariprazine and amisulpride, should be favored over first-generation antipsychotics since they are connected with better functional outcomes, including lower cognitive impairment. An updated clinical algorithm for pharmacological treatment of negative symptoms in schizophrenia recommends cariprazine as first-line treatment to patients with predominantly negative symptoms and amisulpride as a second-line treatment alternative in situations of cariprazine ineffectiveness. Further treatment lines are mentioned in an updated treatment algorithm.

Keywords: schizophrenia, negative symptoms, treatment algoritm, cariprazine, amisulpride