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Risperidone in treatment-refractory schizophrenia
D A Wirshing1, B D Marshall, M F Green
1Department of Psychiatry, VA Greater Los Angeles Healthcare System, CA 90073, USA.
The American Journal of Psychiatry
|September 15, 1999
Summary
Risperidone showed superior efficacy and better tolerability than haloperidol for treatment-refractory schizophrenia patients, particularly those with positive psychotic symptoms and extrapyramidal side effects.
Area of Science:
- Psychiatry
- Pharmacology
Background:
- Schizophrenia is a complex mental disorder.
- Treatment-refractory schizophrenia poses significant challenges.
- Antipsychotic medications are a cornerstone of treatment.
Purpose of the Study:
- To compare the clinical safety and efficacy of risperidone versus haloperidol.
- To evaluate outcomes in patients with treatment-refractory schizophrenia.
Main Methods:
- Randomized assignment of 67 medication-unresponsive patients to risperidone or haloperidol.
- A 4-week double-blind, fixed-dose trial followed by a 4-week flexible-dose phase.
- Standardized psychopathologic and neuromotor instruments were used for assessment.
Main Results:
- Risperidone demonstrated superior Brief Psychiatric Rating Scale (BPRS) efficacy compared to haloperidol after 4 weeks.
- Risperidone-treated patients required less anticholinergic medication and experienced less akathisia and tardive dyskinesia.
- Improvement was significantly greater in the risperidone group (24%) versus haloperidol (11%) at 4 weeks.
Conclusions:
- Risperidone is better tolerated and more effective in a subset of patients with treatment-refractory schizophrenia.
- Positive psychotic symptoms and baseline extrapyramidal side effects predict response to risperidone.