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Pterins as potential treatment to overcome therapeutic resistance in schizophrenia

T.V. Zhilyaeva1, V.I. Larionova2, G.E. Mazo1
1Nizhny Novgorod State Medical Academy, Russia, Nizhny Novgorod
2North Western State Medical University named after I.I. Mechnikov, Russia, Saint-Petersburg
3National Medical Research Center for Psychiatry and Neurology named after V.M. Bekhterev”, Russia, Saint-Petersburg

Summary. The article presents an overview of contemporary literature on the optimization of schizophrenia treatment: the concept of therapeutic resistance in schizophrenia is presented with a short excursus into the history of the development of this problem; the main difficulties in the therapy of negative, cognitive and depressive symptoms of the disease are highlighted; brief information on the search for new methods of treatment optimization in schizophrenia is presented, followed by an emphasis on contemporary data on pterins (folates and tetrahydrobiopterin) as potential methods of optimization of treatment and overcoming the therapeutic resistance in schizophrenia, taking into account the personified approach in the treatment of this disorder. The review presents the main mechanisms of the pathogenesis of schizophrenia, in the realization of which the folate and tetrahydrobiopterin deficiency can participate, a number of biochemical and genetic markers of the impairment of pterin metabolism, found in patients with schizophrenia, as well as the results of folate interventional studies in schizophrenia. Based on the literature data presented, it seems reasonable to consider folates and tetrahydrobiopterin as promising means of personalized correction of resistant schizophrenia, as well as negative, cognitive and affective symptoms of this disorder, which require further study.

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