Review article
Procognitive strategies in the augmentation of antipsychotic therapy in schizophrenia

Modern antipsychotic drugs with the antidopaminergic mechanism supplemented with a serotonergic mechanism are not sufficiently effective against negative and cognitive symptoms of schizophrenia. However, effective pharmacotherapeutic or rehabilitation strategies for these symptoms in the course of schizophrenia have not yet been developed. The aim of the present work is to discuss the theoretical, experimental and clinical trials on the use of combined therapy in schizophrenia based on interventions that can provide cognitive effects.

One of the directions of pharmacotherapy of schizophrenia could become “rational polypharmacy” aimed at improving cognitive functioning. In this regard there are numerous studies of procognitive drugs based on NMDA glutamate receptors, nicotinic cholinergic receptors or dopamine D1 receptors. Clinical effects of these groups of substances so far have not proved satisfactory. On the other hand, extensive research in this direction is being undertaken on agonists or positive modulators of mGlu receptors of groups 2/3 and 5. These substances in preclinical studies proved to be effective against cognitive symptoms of schizophrenia.

In some recent studies, substances with glutamatergic action proved to deliver improvement in fighting both positive and negative symptoms of schizophrenia. However, the procognitive effects of these substances have been demonstrated only in experimental research.