title: New drug developments in psychosis: Challenges, opportunities and strategies.
abstract: All currently approved drugs for schizophrenia work mainly by dopaminergic antagonism. While they are efficacious for psychotic symptoms, their efficacy is limited for negative symptoms and cognitive deficits which underlie the substantive disability in this illness. Recent insights into the biological basis of schizophrenia, especially in relation to non-dopaminergic mechanisms, have raised the efforts to find novel and effective drug targets, though with relatively little success thus far. Potential impediments to novel drug discovery include the continued use of symptom based disease definitions which leads to etiological and pathophysiological heterogeneity, lack of valid preclinical models for drug testing, and design limitations in clinical trials. These roadblocks can be addressed by (i) characterizing trans-diagnostic, translational pathophysiological dimensions as potential treatment targets, (ii) efficiency, accountability and, transparency in approaches to the clinical trials process, and (iii) leveraging recent advances in genetics and in vitro phenotypes. Accomplishing these goals is urgent given the significant unmet needs in the pharmacological treatment of schizophrenia. As this happens, it is imperative that clinicians employ optimal dosing, measurement-based care, and other best practices in utilizing existing treatments to optimize outcomes for their patients today.
authors: Department of Psychiatry, Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Harvard Medical School, United States. Electronic address: mkeshava@bidmc.harvard.edu.
authors: Matcheri S
authors: MS
authors: Keshavan
authors: Department of Psychiatry, Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Harvard Medical School, United States.
authors: Ashley N
authors: AN
authors: Lawler
authors: Department of Neurology & Psychiatry, St Louis University, United States.
authors: Henry A
authors: HA
authors: Nasrallah
authors: Department of Psychiatry, University of Florida, Gainsville, Florida. and the North FL/South Georgia Veterans' Administration Medical Center, Gainesville, FL 32610, United States; The North Florida/South Georgia Veterans' Administration Medical Center, Gainesville, FL, 32610, United States.
authors: Rajiv
authors: R
authors: Tandon
mesh_terms: D000818:Animals; D000928:Antidepressive Agents / Q000009:adverse effects / Q000138:chemical synthesis* / Q000627:therapeutic use*; D055808:Drug Discovery / Q000639:trends*; D019317:Evidence-Based Medicine; D006801:Humans; D011618:Psychotic Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology*; D012559:Schizophrenia / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology*; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents
keywords: Antipsychotics; Clinical trials; Dopamine; Drug development; Efficacy; Glutamate; Pharmacology; Psychosis; Schizophrenia