Past Issues

Clinical Trials in Psychiatry: Focusing on Antipsychotic Development

Shih-Ku Lin

Clinical trial is referred to an experiment to investigate novel therapies including drug, vaccines, dietary choices, dietary supplements, and medical devices or
other intervention to a certain disease or illness, and to assess the contingent side
effects. This overview is to focus on the clinical trial in the development of antipsychotic drugs. Pharmacotherapy is the mainstay of treatment for mental disorders in modern medicine, while there were many interesting and strange therapies
implemented in the early days. These therapies include malaria-induced fever to
treat neurosyphilitic paresis, insulin-induced coma and convulsions to treat schizophrenia, pentylenetetrazole-induced convulsions and electroconvulsive shock
therapy to treat schizophrenia and affective psychoses, and prefrontal lobotomy to
treat psychosis and personality disorder. Lithium, chlorpromazine, imipramine,
chlordiazepoxide, and iproniazid (MAOI) were developed serendipitously by
careful clinical researchers and became the founders of modern psychopharmacology. Currently there are strict regulations and paradigms for clinical trial after decades of evolution. Recently approved antipsychotic drugs such as lurasidone,
brexpiprazole, cariprazine and blonanserin are introduced. They have different
receptor affinity and carry different side effect profiles. Cognition enhancers are
developed using the mechanism of glutamate system modulation, phosphodiesterase inhibition and nicotinic receptor agonism. Inverse agonist in an old concept
and a new antipsychotic has been developed using this concept. Also the clinical
trials and clinical pharmacological studies in psychiatric field done in Taiwan are
reviewed. In the future, precise medicine as getting the right treatment at the right
time to the right person is also important for mental disorders. More precise diagnostic categories based on biological, psychological, and socio-cultural variables,
which need many kinds of data to reach precision of a clinical trial.
Key Word lurasidone, brexpiprazole, cariprazine, cognitive impairment associated with schizophrenia
Editorial Committe, Taiwanese Journal of Psychiatry
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