For decades there has been little progress in the medical treatment of schizophrenia, one of the most debilitating of all mental illnesses, but recent advances have raised hopes of improvement.

The condition often only gains media attention after violent attacks by people who sufferer from the condition, such as when a schizophrenic patient stabbed a nurse to death recently in the French city of Reims.

However, French psychiatrist Sonia Dollfus stresses that such cases of violence by people with schizophrenia are "extremely rare," despite media perceptions fueling public fears.

"All the work done over the years trying to de-stigmatize this disease – it is swept away in 24 hours," Dollfus says. 

Around one in every 300 people worldwide are affected by schizophrenia, according to the World Health Organization. It can cause a variety of distressing delusional disorders, which vary in intensity between sufferers but often massively disrupts their lives. At least five percent of schizophrenia patients are believed to die by suicide.

The condition is usually treated with a combination of anti-psychotic drugs, social support, and psychological therapy.

Scottish psychiatrist Robin Murray, who has spent decades researching schizophrenia, said that despite psychological therapy improving, when it came to medication, "treatment has not changed dramatically" over the last 20 or 30 years.

And unlike numerous other mental disorders – particularly neurotic conditions – pharmaceuticals remain a linchpin of schizophrenia treatment.

Innovation

Dollfus says that for drugs, there has been a "blank period since the 2010s, when pharmaceutical laboratories really withdrew from psychiatry." However, she adds there has been some innovation recently.

One development she says has been using apps that can track patients' progress, ensure timely follow-up sessions and contact psychiatrists if necessary.

Then there is a new treatment approved by the U.S. Food and Drug Administration last month. The drug risperidone has long been used for schizophrenia, but as a daily pill. However, the new approval is for treatment administered via injection, allowing the drug to be progressively released in the body over several weeks.

This makes it impossible for patients to miss a daily pill. Interruptions to medication, often brought about by the psychosis the illness causes, are a common problem in treating schizophrenia. For example, several sources say the attacker in Reims had been off his medication.

A promising avenue 

Dollfus said that some drugs currently being investigated are "really interesting" because they work in a different way than those of the past.

Traditionally, anti-psychotic drugs used to treat schizophrenia were meant to block the action of dopamine, a molecule that acts as a chemical messenger in the brain. However, dopamine seems to play a complex role in schizophrenia, with some patients often having excessive levels in some respects and insufficient levels in others. 

Traditional anti-psychotic drugs, which tend to work well at stopping certain symptoms such as hallucinations, do not help in other areas, such as struggles with language and speech or the loss of willpower.

Recent research has focused on finding other molecules which regulate rather than block dopamine, while also acting on other areas thought to be involved in schizophrenia.

These treatments, such as one that targets a protein called TAAR1, are still some way away from being available to patients. But the TAAR1 drug has had positive results from the most advanced stage of trials, known as phase 3.

Then there's the drug combo KarXT which has shown promise in recent trials for treating positive and negative symptoms in schizophrenia. Instead of directly targeting dopamine in the body, it activates specific neuroreceptors which in turn controls how the dopamine is regulated. 

"This is a really promising avenue," Dollfus said. The search for better treatments continues.

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