The Influence of Gut Microbiota on the Development of Schizophrenia. Ways of Pharmacologic Correction (Systematic Scoping Review)

Introduction. The development of schizophrenia is significantly influenced by the composition and quality of the intestinal microflora. Generalization of knowledge about the nature of the disease allows to define new effective methods of treatment of mental disorders by correcting the patient's microbiota. 

Purpose. The purpose of the article is to analyze, systematize and summarize the scientific data obtained in studies of the relationship of human microbiota with the development of schizophrenia and methods of treatment of the disease.

Materials and Methods. The review includes both Russian and foreign publications published in Russian and English from 2019 to 2025. The databases eLibrary, Cyberleninka, Scopus and Web of Science were used to search for foreign scientific papers. 91 articles were analyzed in the study.

Results. The microbiota, being in a symbiotic relationship with the organism, maintains its homeostasis. Studies have shown that the composition and quality of gut microflora in healthy individuals differ significantly from patients suffering from schizophrenia. This emphasizes the need to maintain normal levels of alpha diversity in the microbiota. The influence of microflora on the development of schizophrenia is explained by the existence of a microbiota-gut-brain axis. A number of bacteria produce neutrotransmitters related to the glutamatergic system of the brain, which play a significant role in the pathogenesis of schizophrenic disorders. Some studies suggest that altered microbiota composition may activate glutamatergic hypofunction. The drugs of first choice in the treatment of schizophrenia are antipsychotic drugs (AD), or neuroleptics. However, they cause a large number of side effects, including gastrointestinal (GI) disorders observed in 1.5%-60% of cases. This makes it urgent to optimize pharmacotherapy of schizophrenia, taking into account the correction of the patient's microbiota. To promote the therapeutic effect of medications, it is recommended to prescribe combinations of pro- and prebiotics, which allow to enrich the intestinal microflora.

Conclusions. Schizophrenia requires a comprehensive approach to therapy. Studies show a link between the composition of the intestinal microflora and the development of the disease. This opens up new strategies for the diagnosis and pharmacotherapy of schizophrenia. Given its association with the microbiota-gut-brain axis, it is important to investigate pro- and prebiotic supplements. They may reduce the side effects of neuroleptics and normalize the composition of the intestinal microflora.

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