In Case You Missed: Utilizing the Muscarinic System to Optimize Treatment Options for Schizophrenia

Schizophrenia is an incurable, neuropsychiatric disease characterized by difficulties thinking and communicating clearly as well as psychosis (ie, “positive” symptoms); difficulty functioning socially (ie, “negative” symptoms); and cognitive impairment. As many as 34% of patients with schizophrenia have treatment-resistant schizophrenia, defined as continuing symptoms despite at least 2 trials of appropriate antipsychotic treatment, and most people do not recover from it. Patients with schizophrenia have a shortened lifespan, with as many as 10% committing suicide. Most current treatments for schizophrenia have focused on dopamine (ie, first-generation antipsychotics, second-generation antipsychotics), which can improve the positive symptoms of schizophrenia. However, these therapies are associated with side effects including extrapyramidal symptoms (EPS) as well as metabolic side effects, in addition to increased risk of cardiometabolic problems, hyperprolactinemia, sexual dysfunction, and menstrual irregularities. Currently, there is no available therapy to improve the negative symptoms of schizophrenia. In recent years, elucidation of the role of muscarinic acetylcholine receptors in the pathogenesis of schizophrenia has increased. The development and investigation of agents targeting the muscarinic system has shown that these agents may be new treatment options for patients with schizophrenia and have shown to improve the negative symptoms of schizophrenia. In this educational activity, expert faculty will review the role of the muscarinic system in the pathogenesis of schizophrenia and will evaluate the latest clinical trial data on emerging muscarinic receptor-targeting agents for the treatment of schizophrenia.