From ‘classical’ antipsychotics to ‘multidimensional stabilizers’: do we need a new classification for novel drugs used in schizophrenia?

SUMMARY This article revisits the roots of the clinical categorical concept of schizophrenia and its biopathogenetic model (‘dopaminergic model’), based on dopaminergic dysfunctioning in CNS, as conceived in the 1960s and 1970s. These clinical/biopathogenic concepts have been challenged by the dimensional approach and by a more complex neurochemical model of schizophrenia, arising mainly from the use of novel compounds, which involves activity on different neurotransmitters in the CNS. Moreover, new compounds used in the treatment of schizophrenia are effective not only on the psychotic dimension, but also on other dimensions, such as negative, depressive and cognitive ones. Therefore, the term ‘antipsychotic’, which refers to a class of drugs acting mainly on acute psychotic symptoms, seems obsolete, and schizophrenia should not be conceived as an acute disorder, but rather as a chronic multidimensional dysfunction. Consequently, novel compounds acting on different dimensions can better stabilize patients, avoiding the shift from positive to negative symptoms due to the D2 antagonism. Thus, a new denomination is needed considering all of the peculiarities of new compounds compared with neuroleptics for stabilizing not just psychotic symptoms in the acute phase, but also affective, negative and anergic symptoms (which are integral parts of the disorder), even in the medium–long term; more appropriately, they should be considered as ‘multidimensional stabilizers’ instead of antipsychotics. Moreover, this denomination also refers to their efficacy in bipolar disorders, since their use is being increasingly proven to be effective in the treatment of this disorder as well. Finally, a change in the name of this pharmacological class may contribute to reducing the stigma that is now closely linked to antipsychotic drugs, such as chronicity, unfavorable prognosis and ‘craziness’.