Pharmacological treatment of schizophrenia: Japanese Expert Consensus 2025 - PubMed
3 hours ago
- #Schizophrenia Treatment
- #Japanese Guidelines
- #Antipsychotics
- The consensus updated the 2021 guidelines by JSCNP, reflecting current clinical practices.
- 154 board-certified psychiatrists evaluated treatments for 21 clinical situations using a 9-point Likert scale.
- First-line antipsychotics vary by symptoms: risperidone, brexpiprazole, olanzapine, paliperidone, blonanserin for positive symptoms; aripiprazole and brexpiprazole for negative symptoms and cognitive impairment; aripiprazole, brexpiprazole, lurasidone, olanzapine, quetiapine for depression/anxiety; brexpiprazole, aripiprazole, olanzapine for disorganized thinking; olanzapine and risperidone for excitement/aggression; and aripiprazole, brexpiprazole, lurasidone for social integration.
- For high risk of extrapyramidal side effects or diabetes, first-line options are brexpiprazole, quetiapine, and aripiprazole.
- Dose reduction or switching is recommended for tardive dyskinesia.
- Long-acting injectable antipsychotics are indicated for repeated recurrence, patient request, and poor adherence.
- Clozapine is the treatment of choice for treatment-resistant schizophrenia.
- Adverse effects are the top factor for dose reduction or simplifying to antipsychotic monotherapy.
- Second-generation antipsychotics are generally first- or second-line, while first-generation ones are often third-line.
- The consensus provides practical guidance for treatment selection and shared decision-making in clinically challenging scenarios.