Review: treatment of schizophrenia. State of the art.

As a result of the multifactorial etiopathology of schizophrenia, a treatment strategy combining drug therapy with psychosocial measures is indicated. Depending on the stage of the disease and on the individual condition of the patient, the accent is set alternatively more on one approach or on the other. However, under aspects of symptom reduction and relapse prophylaxis, the therapy with neuroleptics plays the most important role. In order to keep their side effects to a minimum during acute and long term treatment, there is nowadays a trend towards administration of the lowest possible dose. Under this aspect, the use of so called atypical neuroleptics should be taken into consideration. The treatment of negative symptoms, especially in the context of chronic residual syndrome, is still a problem which hasn't been solved to satisfaction. Beside the use of atypical neuroleptics, treatment with antidepressives should be tried. During the long term relapse prophylactic treatment, it is important that not only the criterion "reduction of the relapse rate" but also that of individual risk/benefit relation be considered. Concerning psychosocial therapies, especially focused behavioural therapy approaches, for example educational programs and specific family therapeutical intervention following the high-EE-concept, as well as training of social and cognitive competences have proved useful beside supportive psychotherapy and the whole range of sociotherapeutical measures. However they need further evaluation before they get integrated in routine treatment.