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Finally progress in the treatment of schizophrenia?



(AFP) – In a few decades, medical research has made little progress in the face of schizophrenia, a pathology recently exposed in French news after the death of a nurse killed by a patient. But new molecules could finally come into play.

For twenty or thirty years, “drug treatments have not fundamentally changed”, summarizes with AFP the Scottish psychiatrist Robin Murray, who has devoted decades of research to schizophrenia.

In France, this serious psychiatric disorder has just been highlighted with the murderous attack this week of a nurse in Reims by a schizophrenic patient. At the risk of stigmatizing all patients.

“All the work done for years to try to de-stigmatize this disease, it is swept away in 24 hours”, regrets to AFP the psychiatrist Sonia Dollfus, underlining the “extremely rare” nature of this act.

For most schizophrenic patients – estimated at one in 300 people worldwide by the World Health Organization (WHO) – the disease represents a danger first and foremost for themselves, in particular because the frequency of suicides are high there (5%).

More broadly, schizophrenia, which results in a wide range of delusional disorders of varying intensity from one patient to another, often deeply disrupts their personal and social life.

The treatment is complex and generally combines the taking of a drug with social reintegration assistance and psychotherapy.

On this last level, follow-up has improved in recent decades, according to Mr. Murray, who evokes a decline in psychoanalytic therapies, which are ineffective or even counterproductive in the face of such psychotic disorders.

On the other hand, in the medicinal field, the situation has remained largely the same for many years. However, in contrast to other mental disorders – in particular neurotic ones – the taking of a drug remains the cornerstone of the psychiatric treatment of schizophrenia.

But after “a blank from the 2010s when the laboratories really disinvested in psychiatry (…), there is really innovation”, notes Ms. Dollfus.

– “Promising” track –

In the immediate future, the concrete innovations concern the follow-up of patients, with for example the development of computer applications facilitating contact with one’s psychiatrist, and the mode of administration of already known drugs.

Thus, the American health authorities approved in April a treatment developed by the Israeli Teva and the French MedinCell. The molecule, already well known to psychiatrists, will be administered by injection and no longer orally.

The drug can thus be released gradually in the body over several weeks, instead of requiring daily intake.

The challenge is to enable better drug monitoring when many patients are led by their disorders to interrupt the systematic intake of their treatment; according to several sources, this was the case of the author of the attack in Reims.

Although this is a promising advance on the therapeutic level, we cannot, however, speak of a revolution as would be the appearance of new molecules. But, in this area too, progress finally seems possible.

“Drugs currently being explored are really interesting because of their new mechanisms of action,” explains Ms. Dollfus.

The molecules currently used in schizophrenia essentially boil down to a single mode of action: they block the action of dopamine, a molecule with central action in the nervous system.

However, dopamine seems to play a complex role in schizophrenia – both excessive on certain levels and insufficient on others – and these treatments, which are quite effective against symptoms such as hallucinations, do not improve other facets of the disease, such as the loss of will or of a constructed language.

Faced with this observation, research has recently focused on other molecules, whose mode of action is broader by regulating rather than blocking the transmission of dopamine while acting in parallel on other molecules potentially involved in the schizophrenic disorders.

Without yet making it possible to consider immediate marketing, research on these treatments, which target in particular a protein called TAAR1, is at an advanced stage: large-scale studies, called “phase 3”, are beginning to record good results.

“It’s a track that is really promising,” concludes Ms. Dollfus.

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