How Clinicians Can Brush Up on Emerging Schizophrenia Drugs

At the recent Psych Congress 2023, a session titled “State of the Science: Focus on Schizophrenia” was presented by Peter Weiden, MD, a clinical professor of psychiatry at the Renaissance School of Medicine at Stony Brook University in New York. Weiden provided an overview of the latest research findings and emerging treatments in schizophrenia.

In a recent MedPage Today video, Weiden told clinicians to be prepared for new options expected to hit the field over the next few years. In this video, Weiden follows his previous message with some advice on what clinicians can do in the meantime.

Following is a transcript of his remarks:

You may say, well, what do I tell my patients? What do I do? Let’s not over-promise, which I agree with. But what I would do if I were you, or what I have done for myself is, actually, I’ve learned on YouTube new receptors, new drugs in other areas. I’ve taken YouTube classes for medical students, and it’s blown my mind to see how these mechanisms have changed. I did do a talk recently on this, we will be publishing on this, but it’s really cool.

The other thing I would suggest between now and one of the new drugs coming out is it’s very likely that the first of these new non-dopamine antipsychotics coming out will be a muscarinic receptor agonist. Now, we use drugs like acetylcholinesterase inhibitors for Alzheimer’s, and those lead to side effects or benefits. Learn about that, or learn about muscarinic receptors, what they do in the brain, and what they do in the periphery. There’s been an explosion of knowledge.

And my final clinical tip to you is the more we learn about muscarinic systems, the more we know that central anticholinergic activity, if you take away muscarinic receptors in the brain, that’s really bad. That is bad for cognition, that is bad for many reasons.

So today, start thinking about how much anticholinergic burden does your prescription add to that patient? And if it’s a lot, try to think of ways to lower that. Like benztropine (Cogentin) — can you offload the Cogentin? You don’t need to use Cogentin very often for EPS [extrapyramidal symptoms] anymore. It’s sort of outdated. Haldol (haloperidol) is a little outdated. Used to be considered safe, Haldol. It’s not so safe in many ways, but one of them is you have to use a lot of Cogentin, or benztropine.

So, start thinking about that. You’re going to stay tuned. You will hear a lot more about that in the future. And thank you for listening.

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