Agota Barabassy

By Agota Barabassy, Balázs Szatmári, István Laszlovszky and György Németh

The aim of the chapter is to raise awareness about recent constructs of negative symptoms, their burden on patients, caregivers and society, and about their management. Schizophrenia consists of positive, negative, and cognitive symptoms. However, treating physicians are not necessarily aware about recent constructs of negative symptoms, their presence at prodromal stage, and the distinction among primary, secondary, persistent, prominent, or predominant negative symptoms. Negative symptoms have a substantial impact on the day-to-day functioning of patients with schizophrenia and contribute more to impaired quality of life and poor functioning than positive symptoms do. Additionally, they are associated with high costs for society and a substantial burden for caregivers. Negative symptoms are not adequately treated by available antipsychotic therapies. Publications have shown that no antipsychotic has a beneficial effect when compared to another. Cariprazine is the only antipsychotic that has proven superiority over another antipsychotic (risperidone) in one clinical study.

Part of the book: Psychotic Disorders

By Zsófia Borbála Dombi, Ágota Barabássy, Barbara Sebe, István Laszlovszky and György Németh

The aim of this chapter is to summarize the state-of-the-art knowledge of clinical staging in schizophrenia spectrum disorders. Clinical staging has been introduced to psychiatry in the past two decades. Its primary goal is to divide the course of the disorder into recognizable stages based on seriousness, development and symptom characteristics in order to better predict prognosis and to adopt the most appropriate treatment strategies. The first staging model was developed in 1982. Since then several distinct concepts of clinical staging in psychiatry have emerged. To date, there is no clinical consensus regarding which staging model is the gold standard, nonetheless when merging them together an integrated staging concept arises. The integrated staging model of schizophrenia spectrum disorders is composed of four stages. The chapter will introduce the different staging models in a historical order as well as present the integrated staging model detailing the characteristics, timeline and dominating symptoms of each stage. Appropriate treatment strategies for the distinct stages will also be outlined.

Part of the book: Psychosis

By Agota Barabassy, Zsófia B. Dombi, Réka Csehi and Darko Djuric

Schizophrenia is a long-term disease that needs to account for acute symptom control and long-term treatment needs such as relapse prevention, remission, and safety. The aim of the present book chapter was to summarize available literature data and guidelines on how to treat specific symptoms of schizophrenia and what aspects to consider long term. Looking at single symptoms, clozapine was better than all other antipsychotics in addressing positive and hostility symptoms of schizophrenia: however, it is not first-line treatment. Cariprazine showed superior efficacy in treating primary negative symptoms and is treatment of choice for these symptoms. Additionally, partial agonists (aripiprazole, brexpiprazole, cariprazine) were better in addressing comorbid substance use, while quetiapine, cariprazine, and olanzapine/fluoxetine showed advantages in treating mood disorders. In long term, there was no difference between antipsychotics in addressing relapse and remission; however, distinct differences in safety aspects are seen; overall, newer generation antipsychotics (aripiprazole, brexpiprazole, cariprazine, and lurasidone) are favored over other antipsychotics. In summary, careful consideration should be applied when choosing the right treatment for schizophrenia, accounting for prevalent symptoms, longitudinal aspects, psychiatric and somatic comorbidities as well as preference of patients.

Part of the book: New Approaches to the Management and Diagnosis of Schizophrenia [Working title]