CC BY-NC-ND 4.0 · Pharmacopsychiatry 2021; 54(02): 60-67
DOI: 10.1055/a-1324-3517
Original Paper

Pharmacological Treatment of Schizophrenia: Japanese Expert Consensus

Hitoshi Sakurai
1   Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
2   Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
Norio Yasui-Furukori
3   Department of Psychiatry, Dokkyo Medical University School of Medicine, Tochigi, Japan
Takefumi Suzuki
4   Department of Neuropsychiatry, University of Yamanashi Faculty of Medicine, Yamanashi, Japan
Hiroyuki Uchida
2   Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
Hajime Baba
5   Department of Psychiatry & Behavioral Science, Juntendo University Graduate School of Medicine, Tokyo, Japan
Koichiro Watanabe
6   Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
Ken Inada
7   Department of Psychiatry, Tokyo Women’s Medical University School of Medicine, Tokyo Japan
Yuka Sugawara Kikuchi
8   Department of Psychiatry, Akita University School of Medicine, Akita, Japan
Toshiaki Kikuchi
2   Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
Asuka Katsuki
9   Department of Psychiatry, University of Occupational and Environmental Health, Fukuoka, Japan
Ikuko Kishida
10   Fujisawa Hospital, Kanagawa, Japan
11   Department of Psychiatry, Yokohama City University School of Medicine, Kanagawa, Japan
Masaki Kato
12   Department of Neuropsychiatry, Kansai Medical University, Osaka, Japan
› Author Affiliations


Introduction Conventional treatment guidelines of schizophrenia do not necessarily provide solutions on clinically important issues.

Methods A total of 141 certified psychiatrists of the Japanese Society of Clinical Neuropsychopharmacology evaluated treatment options regarding 19 clinically relevant situations in the treatment of schizophrenia with a 9-point scale (1=“disagree” and 9=“agree”).

Results First-line antipsychotics varied depending on predominant symptoms: risperidone (mean±standard deviation score, 7.9±1.4), olanzapine (7.5±1.6), and aripiprazole (6.9±1.9) were more likely selected for positive symptoms; aripiprazole (7.6±1.6) for negative symptoms; aripiprazole (7.3±1.9), olanzapine (7.2±1.9), and quetiapine (6.9±1.9) for depression and anxiety; and olanzapine (7.9±1.5) and risperidone (7.5±1.5) for excitement and aggression. While only aripiprazole was categorized as a first-line treatment for relapse prevention (7.6±1.0) in patients without noticeable symptoms, aripiprazole (8.0±1.6) and brexpiprazole (6.9±2.3) were categorized as such for social integration. First-line treatments in patients who are vulnerable to extrapyramidal symptoms include quetiapine (7.5±2.0) and aripiprazole (6.9±2.1).

Discussion These clinical recommendations represent the expert consensus on the use of a particular antipsychotic medication for a particular situation, filling a current gap in the literature.

Supplementary Material

Publication History

Received: 19 November 2020
Received: 16 July 2020

Accepted: 22 November 2020

Article published online:
12 January 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany