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Extrapyramidal Symptoms During Risperidone Maintenance Treatment in Schizophrenia: A Prospective, Multicenter Study
Qi-Jing Bo1, Xian-Bin Li, Zhi-Min Wang
1From the *Beijing Key Laboratory of Mental Disorders, Department of Psychiatry, Beijing Anding Hospital, Capital Medical University; and †Center of Schizophrenia, Beijing Institute for Brain Disorders, Laboratory of Brain Disorders (Capital Medical University), Ministry of Science and Technology, Beijing, China.
Journal of Clinical Psychopharmacology
|February 6, 2016
Summary
This study found that gradual risperidone dose reduction over 4 or 26 weeks, compared to no reduction, led to differential decreases in extrapyramidal symptoms (EPS) in schizophrenia patients over one year.
Area of Science:
- Psychiatry and Behavioral Sciences
- Clinical Pharmacology
- Neuroscience
Background:
- Schizophrenia treatment often involves long-term antipsychotic medication like risperidone.
- Extrapyramidal symptoms (EPS) are common side effects of antipsychotics, impacting treatment adherence.
- Optimal risperidone maintenance strategies balancing efficacy and tolerability require further investigation.
Purpose of the Study:
- To compare the incidence and severity of extrapyramidal symptoms (EPS) under different risperidone maintenance treatment paradigms.
- To identify the optimal duration of risperidone dose reduction for managing EPS in schizophrenia patients.
- To analyze the long-term impact of risperidone dose reduction strategies on treatment outcomes and tolerability.
Main Methods:
- A 1-year randomized controlled trial involving 374 clinically stabilized schizophrenia patients.
- Patients were assigned to three groups: no dose reduction, 4-week dose reduction, or 26-week dose reduction (50% decrease over 8 weeks).
- Extrapyramidal symptom (EPS) severity was assessed monthly using the Simpson-Angus Scale, with data analyzed via generalized linear mixed models (GLMM).
Main Results:
- Baseline EPS frequency was similar across groups (20.0%–23.2%), with risperidone dosage and symptom severity predicting EPS development.
- After 1 year, EPS incidence decreased significantly in all groups, with lower rates in the 4-week (4.1%) and 26-week (2.8%) reduction groups compared to no reduction (10.0%).
- Dropout rates due to intolerable EPS did not significantly differ between the groups.
Conclusions:
- Gradual risperidone dose reduction, particularly over 4 or 26 weeks, can lead to differentially decreased and tolerable extrapyramidal symptoms in schizophrenia patients.
- The findings suggest that tailored dose reduction strategies may improve long-term management of antipsychotic side effects.
- Generalized linear mixed models (GLMM) are recommended for future investigations into long-term antipsychotic adverse effects.
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