Risperidone and haloperidol in first-episode psychosis: a long-term randomized trial

Area of Science:

• Psychiatry and Pharmacology
• Clinical Neuroscience
• Mental Health Treatment

Background:

• First episode of psychosis is a critical juncture for treatment adherence and long-term outcomes.
• Effective initial pharmacotherapy and sustained relapse prevention are crucial for managing psychotic illness.
• Antipsychotic medication choice impacts patient willingness to continue treatment and overall prognosis.

Purpose of the Study:

• To compare the long-term effectiveness of risperidone and haloperidol in patients experiencing their first episode of psychosis.
• To evaluate relapse rates and time to relapse for both risperidone and haloperidol.
• To assess adverse effects associated with long-term treatment with these antipsychotics.

Main Methods:

• A double-blind, randomized, controlled trial involving 555 first-episode psychosis patients.
• Flexible dosing of risperidone (mean modal dose 3.3 mg) and haloperidol (mean modal dose 2.9 mg).
• Median treatment duration of 206 days, with a maximum of 1,514 days.

Main Results:

• Both risperidone and haloperidol significantly improved Positive and Negative Syndrome Scale scores and Clinical Global Impression ratings from baseline.
• While 75% of patients achieved initial clinical improvement, risperidone showed a lower relapse rate (42%) compared to haloperidol (55%).
• Risperidone demonstrated a significantly longer median time to relapse (466 days) than haloperidol (205 days) and fewer extrapyramidal symptoms, though it caused greater prolactin elevation.

Conclusions:

• Low-dose antipsychotics effectively alleviate symptoms in most first-episode psychosis patients.
• Risperidone offers superior long-term relapse prevention and a longer time to relapse compared to haloperidol.
• Risperidone is associated with fewer abnormal movements than haloperidol, making it a potentially more tolerable long-term option.