Pharmacological treatment of negative symptoms in schizophrenia: update and proposal of a clinical algorithm

Giancarlo Cerveri,1 Camilla Gesi,2 Claudio Mencacci21Mental Health Department, ASST Lodi, Lodi, Italy; 2Mental Health Department, ASST Fatebenefratelli-Sacco, Milan, ItalyAbstract: The clinical presentation of schizophrenia encompasses symptoms divided into three dimensions: positive, negative, and...

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Autores principales:	Cerveri G, Gesi C, Mencacci C
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2019
Materias:	cariprazine mental disorders symptoms Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/f45819950f414a61b3579ec92f15b2c7
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spelling	oai:doaj.org-article:f45819950f414a61b3579ec92f15b2c72021-12-02T02:17:57ZPharmacological treatment of negative symptoms in schizophrenia: update and proposal of a clinical algorithm1178-2021https://doaj.org/article/f45819950f414a61b3579ec92f15b2c72019-06-01T00:00:00Zhttps://www.dovepress.com/pharmacological-treatment-of-negative-symptoms-in-schizophrenia-update-peer-reviewed-article-NDThttps://doaj.org/toc/1178-2021Giancarlo Cerveri,1 Camilla Gesi,2 Claudio Mencacci21Mental Health Department, ASST Lodi, Lodi, Italy; 2Mental Health Department, ASST Fatebenefratelli-Sacco, Milan, ItalyAbstract: The clinical presentation of schizophrenia encompasses symptoms divided into three dimensions: positive, negative, and cognitive. Negative symptoms (NS), in particular, have a major impact on the quality of life of the affected subject, and, differing from positive symptoms, are often associated with a limited response to pharmacotherapy. To date, studies specifically investigating NS in schizophrenia are scant; therefore, proper selection of therapy for NS remains a major unmet medical need. Given the heterogeneity of the clinical presentation of schizophrenia, the treatment of NS, as well as therapy for other associated symptoms, should be largely individualized according to a patient’s specific characteristics. In this paper, we review current knowledge on NS and construct a clinical algorithm for the treatment of schizophrenic conditions with pronounced NS. Overall, data from the literature suggest that second-generation antipsychotics, such as cariprazine and amisulpride, should be preferred over first-generation antipsychotics (FGAs), as they are associated with better functional outcomes and lower cognitive impairment. The combination of antipsychotics and antidepressants may also improve NS while addressing some affective disorders associated with schizophrenia; however, no clear information is available on the effects of this combination on primary NS or on the mechanism of action of the combination. In the proposed clinical algorithm, we suggest that cariprazine should be used as first-line treatment for patients with predominant NS, and that amisulpride should be considered as an alternative in cases of cariprazine failure. Further treatment lines may include the use of olanzapine and quetiapine, and add-on therapy with antidepressants.Keywords: cariprazine, mental disorders, symptomsCerveri GGesi CMencacci CDove Medical Pressarticlecariprazinemental disorderssymptomsNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571Neurology. Diseases of the nervous systemRC346-429ENNeuropsychiatric Disease and Treatment, Vol Volume 15, Pp 1525-1535 (2019)
institution	DOAJ
collection	DOAJ
language	EN
topic	cariprazine mental disorders symptoms Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
spellingShingle	cariprazine mental disorders symptoms Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429 Cerveri G Gesi C Mencacci C Pharmacological treatment of negative symptoms in schizophrenia: update and proposal of a clinical algorithm
description	Giancarlo Cerveri,1 Camilla Gesi,2 Claudio Mencacci21Mental Health Department, ASST Lodi, Lodi, Italy; 2Mental Health Department, ASST Fatebenefratelli-Sacco, Milan, ItalyAbstract: The clinical presentation of schizophrenia encompasses symptoms divided into three dimensions: positive, negative, and cognitive. Negative symptoms (NS), in particular, have a major impact on the quality of life of the affected subject, and, differing from positive symptoms, are often associated with a limited response to pharmacotherapy. To date, studies specifically investigating NS in schizophrenia are scant; therefore, proper selection of therapy for NS remains a major unmet medical need. Given the heterogeneity of the clinical presentation of schizophrenia, the treatment of NS, as well as therapy for other associated symptoms, should be largely individualized according to a patient’s specific characteristics. In this paper, we review current knowledge on NS and construct a clinical algorithm for the treatment of schizophrenic conditions with pronounced NS. Overall, data from the literature suggest that second-generation antipsychotics, such as cariprazine and amisulpride, should be preferred over first-generation antipsychotics (FGAs), as they are associated with better functional outcomes and lower cognitive impairment. The combination of antipsychotics and antidepressants may also improve NS while addressing some affective disorders associated with schizophrenia; however, no clear information is available on the effects of this combination on primary NS or on the mechanism of action of the combination. In the proposed clinical algorithm, we suggest that cariprazine should be used as first-line treatment for patients with predominant NS, and that amisulpride should be considered as an alternative in cases of cariprazine failure. Further treatment lines may include the use of olanzapine and quetiapine, and add-on therapy with antidepressants.Keywords: cariprazine, mental disorders, symptoms
format	article
author	Cerveri G Gesi C Mencacci C
author_facet	Cerveri G Gesi C Mencacci C
author_sort	Cerveri G
title	Pharmacological treatment of negative symptoms in schizophrenia: update and proposal of a clinical algorithm
title_short	Pharmacological treatment of negative symptoms in schizophrenia: update and proposal of a clinical algorithm
title_full	Pharmacological treatment of negative symptoms in schizophrenia: update and proposal of a clinical algorithm
title_fullStr	Pharmacological treatment of negative symptoms in schizophrenia: update and proposal of a clinical algorithm
title_full_unstemmed	Pharmacological treatment of negative symptoms in schizophrenia: update and proposal of a clinical algorithm
title_sort	pharmacological treatment of negative symptoms in schizophrenia: update and proposal of a clinical algorithm
publisher	Dove Medical Press
publishDate	2019
url	https://doaj.org/article/f45819950f414a61b3579ec92f15b2c7
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_version_	1718402566185811968

Pharmacological treatment of negative symptoms in schizophrenia: update and proposal of a clinical algorithm

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