The treatment of schizophrenia is on the threshold of major new advances. The focus of this workshop will be to review a new class of agents that do not bind to dopamine receptors, like all other antipsychotic drugs, but have their effects mediated through muscarinic receptors.  The most advanced muscarinic agent is xanomeline plus trospium known as KarXT.  In this keynote, the relevant data associated with KarXT will be reviewed including its history, pharmacology, and clinical trial efficacy and safety results. This agent was submitted to the FDA for the treatment of schizophrenia last year and has an approval date of September 26, 2024.  If approved, it could be available to our patients before the end of this year.  

Following decades of achievement, I rocketed into full-blown mania. My boss, the Chairman of the Joint Chiefs of Staff, gave me a choice, “…resign or be fired...and get a psychiatric evaluation!”  Plunging into hopeless depression and terrifying psychosis, doctors diagnosed me with bipolar disorder type 1 with psychosis. In “bipolar hell” for two years, I was hospitalized, prescribed various medications and therapies (including electroconvulsive therapy), and finally, began to recover, due mainly to lithium. Brutally candid, this is my story: from success to bipolar onset in combat, crisis, recovery, new life, and lessons learned. This book and its lessons apply to all those touched by mental illness - the afflicted, the affected, and caregivers - virtually the entire population.