And above all discuss the different therapeutic alternatives for schizophrenia in 2025
1. Le glutamate :
Until now, as a brain system that can explain schizophrenic symptoms, only the so-called dopaminergic (Dopamine D2 receptor) and serotonergic (5-HT2A serotonin receptor) systems have attracted the attention of researchers.
Medications that use these systems have proven effective on what are known as the positive symptoms of schizophrenia, namely delusional symptoms and behavioral disorders. On the other hand, they have not shown sufficient effectiveness on the so-called negative symptoms of the disease such as social isolation and cognitive deficits.
In order to overcome this serious problem, research in this area is moving towards what is called the NDMA system in which glutamate seems to play a role in the genesis of schizophrenic symptoms, particularly negative symptoms. Some results seem promising, especially in animals, but the transposition to humans has still not shown convincing results, in their current form.
The brain mGlu2 glutamate receptor (mGluR2) nevertheless remains the main target of a new generation of antipsychotics currently still in clinical trials which attempts to effectively treat all the symptoms of schizophrenia without causing notable side effects.
2. Nanocorps : llama single-chain antibodies (so-called nanobodies) actually specifically target mGluR2 in order to purify the endogenous receptor and its interactors from the mouse prefrontal cortex, a brain region known to strongly express mGluR2 but also strongly disrupted in schizophrenia. They do not constitute a therapeutic research avenue but they are used to facilitate the therapeutic effects of glutamate-based drugs.
One innovation consists of the use of “nanobodies”, small proteins derived from antibodies, capable of crossing the blood-brain barrier.
These treatments could provide long-lasting effects after a single injection, with promising preliminary results in mice.
However, their development will still require several years.
3. Repetitive transcranial magnetic stimulation (rTMS): (It has been used at the Villa des Lilas for around ten years)
rTMS (Repeated Transcranial Magnetic Stimulation) is an innovative therapeutic technique which relies on the use of magnetic fields to modulate brain activity.
For several years, rTMS has been the subject of growing interest in the treatment of neurological and psychiatric diseases, particularly because it is a non-invasive therapeutic tool.
A new type of rTMS has been developed very recently, called theta burst, which consists of delivering a series of short pulses at very high frequency, with the advantage of a shorter treatment duration. This technique, applied to the left dorsolateral prefrontal cortex, appears effective in the treatment of patients with schizophrenia, and not other types of rTMS, according to a Japanese meta-analysis.
4. Digital therapies:
In patients suffering from auditory hallucinations, digital therapy using an avatar to embody the voices they hear helps reduce the distress they generate.
Auditory verbal hallucinations are common in patients with schizophrenia, often causing them distress and impairing their quality of life.
Digital therapies are emerging as interesting avenues in psychiatry in particular, such as avatar therapy. In particular, for patients who hear voices, it is a question of embodying them in an avatar represented on a screen with which it is possible to communicate.
Initial studies have suggested that this approach, combined with supportive therapy, can reduce the severity of hallucinations when carried out by therapists trained in a research setting.
4. Virtual reality:
Virtual environments do not aggravate the symptoms of schizophrenic subjects as we tend to think, but provide the possibility of developing new therapeutic tools, in particular by soliciting their ability to act intentionally on themselves, on others and on their environment.
The use of these new techniques still remains marginal in the treatment of pathologies such as schizophrenia, particularly because of the variously assessed risks of a loss of reality in the subject.
However, if these techniques are currently little used in the treatment (and understanding) of schizophrenia, they represent, more than a simple avenue, more than a simple research hypothesis, an indisputable potential therapeutic means. .
5. Genetics and brain imaging:
Advances in genetics and brain imaging are helping to better understand schizophrenia in its organic counterpart and to refine treatments according to the specific characteristics of each patient, targeting their needs and limiting side effects.
Although these innovations are promising, their clinical integration will require rigorous scientific validations and considerable investments as well as the understanding of the disease in its psychopathology which will undoubtedly be of certain benefit.
Schizophrenia remains a complex pathology, requiring a multidimensional approach combining medications, psychotherapy and psychosocial support.
