Dr. Henry A. Nasrallah, chief of the Division of Neuropsychiatry at St. Louis Medical School, gave a presentation titled “Beyond Dopamine: Therapeutic Developments in Schizophrenia” at the American Psychiatric Association (APA) 2015 Annual Meeting. The report noted that 95 percent of patients with first-episode psychosis have consulted with primary care providers prior to the episode, demonstrating the importance of identifying prodromal symptoms and risk factors. Dr. Nasrallah noted that as a neurodevelopmental disorder characterized by progressive brain atrophy, we need to detect schizophrenia in a timely manner. As the number of episodes increases, the ventricular system expands in patients with schizophrenia, Nasrallah says. “Can’t we do something about it?” Nasrallah points out that first there is loss of gray matter, with “significant loss of parietal, temporal and prefrontal cortices”; there is also loss of dendritic spines, which are the basis of cognition and memory. Although we find evidence of neurodegenerative lesions in schizophrenia, “we have been focusing on dopamine.” In addition to overall gray matter and dendritic spine loss, neuroglia in schizophrenia die, or as a result, their gray matter is deficient, rather than due to neuronal loss. “During psychotic episodes,” Dr. Nasrallah found, “glial cells die and neurons become isolated. The effect of schizophrenia on neuroglia remains a hot topic of much research, but the nature of the understanding of the effect’s role is still controversial. To add insult to injury, neurons gain support and the ability to differentiate, and the trophic factors on which they depend are similarly affected, such as brain-derived neurotrophic factor (BDNF). Researchers have conducted numerous studies on neurogenesis and antipsychotic drugs and found that second-generation atypical antipsychotics increase neurogenesis. Furthermore, atypical antipsychotics may increase neurotrophic factor levels in the brain of schizophrenic patients. Given the evidence from a large number of relevant studies, can neurochemical models of schizophrenia outperform dopamine?Dr. Nasrallah questions the focus on neuromediator systems alone. “Why don’t we use GABA agonists in combination with dopamine antagonists?” The antihypertensive drug sodium nitroprusside (nitroprusside) may be effective in treating schizophrenia. Oxytocin (oxytocin) is also a possibility. Dr. Nasrallah believes treatment should focus on the neurodevelopmental dimension of schizophrenia. Prevention may also be helpful, such as avoiding maternal exposure to factors associated with increased risk of schizophrenia, such as: maternal infections, toxoplasmosis and gestational diabetes; and ensuring safe delivery. Dr. Nasrallah also suggests that we prevent neurodegeneration and minimize the risk of psychosis by early intervention with long-acting atypical antipsychotics. In summary, Dr. Nasrallah believes that we urgently need “treatments and strategies that break away from our current treatment focus.”