From the concept of "antipsychotic" to that of "multidimensional normostabilizer": the clinical-therapeutic itinerary of schizophrenia

This paper reviews 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 60's and 70's. These clinical/biopathogenetical concepts have been challenged by the new dimensional approach and by a more complex neurochemical model for Schizophrenia, arising mainly from the use of novel compounds which act on different neurotransmitters in the CNS. Moreover, new compounds used in the treatment of schizophrenia are effective not exclusively on the psychotic dimension but also on other, as negative, depressive and cognitive ones. Therefore, the term "antipsychotic", which named a class of drugs acting mainly on acute psychotic symptoms, seems obsolete, and Schizophrenia is not anymore conceivable as an acute disorder, but as a chronic multidimensional dysfunctioning. Consequently, novel compounds acting on different dimensions can better stabilize patients, avoiding the shifts from positive to negative symptoms, due to the D2 antagonism. Thus, a new denomination is needed considering all these peculiarity of new compounds compared to neuroleptics in order to stabilize not just psychotic symptoms in the acute phase, but also affective, negative and anergic symptoms (which are integral part of the disorder) even in the mediumlong term: more appropriately they should be considered as "multidimensional normostabilizers", instead of antipsychotics.