“Golden Shot” in the Treatment and Diagnosis of Schizophrenia: Psychiatrists or Neuroscientists?
Authors: Dubatova Irina Vladimirovna , Antsyborov Lema Andreevich , Kheigetian Artur Fedorovich , Antsyborov Andrey Viktorovich 
Published: December 2021

The available published data indicate that antagonism towards D2 receptors of dopamine is a «necessary condition» in the process of effective treatment of schizophrenia, but at the same time, this antagonism is insufficient to achieve a state of complete remission. These data serve as a powerful stimulus for the process of searching new treatments and synthesizing new drugs. The current status of the theory of neural networks demonstrates to the professional community that in order to effectively change the functioning of basic biological systems, a number of subtle changes in the central nervous system are required, which are possible with the use of certain substances. The influence of modulation of glutamate on these processes is currently a very «popular» direction both in neurobiology and in clinical psychiatry. At the same time, the role of the latter in the pathogenesis of a number of mental disorders remains unproven. In parallel with this direction, the mechanisms of serotonergic and cholinergic effects on the main components of the pathogenesis of mental disorders are being studied and used in the development of new antipsychotic drugs. Most antipsychotic drugs which belong to «new wave» exhibit an affinity for different types of receptors, which mediate the effect on several therapeutic targets. In practice, a large number of patients take certain drugs not only as monotherapy, but often combine them with other drugs. At the same time, the effectiveness of such therapeutical regimens is low. Therefore, in most modern protocols, monotherapy is still recommended. In recent years, there has been a growing body of research on pharmacotherapy augmentation strategies. The results of these studies demonstrate that augmentation preparations belonging to different pharmacological classes can be generally effective, not only in certain diseases, but also in certain types of patients. In attempts to create a model of «rational polypharmacy», it is very important to accurately define and target the therapy to «problematic symptoms», and it is also necessary to develop an optimal withdrawal strategy from the active therapy regimen. To date, the only existing «lifeline» is Clozapine, which, despite its many disadvantages, remains an effective therapeutic agent for resistant forms of schizophrenic spectrum disorders. New methods of drug synthesis, including «individual drug affinity» analysis and strategies based on the study of gene polymorphism, look promising in the context of antipsychotic drug development. It is unlikely that there will be a «golden shot» for the schizophrenic spectrum disorders in the coming decades, both in terms of diagnostics and treatment. There is a hope that some of the strategies currently being developed (polypharmacy, augmentation), along with new antipsychotic drugs entering the pharmaceutical market, will ultimately become the «shot» that the professional community, patients and their families are looking forward to.