Integrated treatment of schizophrenia [Il trattamento integrato della schizofrenia]

Psychosocial therapies play an important role in the treatment of schizophrenia. These therapies are aimed at improving the functioning of the patient in the community, which in turn can lead to clinical improvement, such as reduction in the number of relapses or hospitalizations. Substantial evidence supports the use of many psychosocial therapies in schizophrenia, including cognitive behavioral therapy, assertive community treatment, cognitive remediation and functional skills training. The customization of pharmacological therapy in schizophrenia, besides the experience of the clinician and individual preferences of the patient, should be based on three sets of objective data: 1) clinical predictors of response to therapy; 2) predictable side effects of therapy; 3) pharmacogenetic and pharmacogenomic data. It has been made a considerable effort to improve adherence to antipsychotic treatment through the development of drugs with better tolerability, in formulations that enable long-term administration of the drug, including injectable long-acting (depot) antipsychotics. In recent years the development of these formulations of atypical antipsychotics and the promising results obtained in clinical trials are changing the attitude toward these drugs, traditionally reserved for patients with repeated non-adherence to treatment.