[The quest for the pharmacological treatment of schizophrenia: from conventional neuroleptics to atypical antipsychotics and beyond].

Schizophrenia is a common and impairing illness for which no treatment was available until the 2nd half of the last century. The introduction of antipsychotics changed forever the fate of sufferers. In addition to treating patients, antipsychotics have served as the main research tool in the effort to elucidate the neurochemistry of positive and negative symptoms of schizophrenia and thus foster the development of ever better therapeutic approaches. The dopaminergic theory of schizophrenia and insights on the role of serotonin and other neurotransmitters in psychosis have emerged as a result. However, none of these drugs is devoid of adverse effects, which can affect different systemic functions and present in varying degrees of severity and duration. From the advent of chlorpromazine and the conventional antipsychotics through the arrival of clozapine and other atypical antipsychotics, to the launch of newer compounds like aripiprazole and asenapine, clinicians have always had to carefully consider the inevitable trade-off between therapeutic efficacy and safety profile of the drugs they prescribe. Despite the decisive advances in the treatment of schizophrenia in the nearly sixty years since chlorpromazine was introduced, this is likely to remain the central tenet of psychiatric prescribing for many decades to come.