Risperidone therapy in treatment refractory acute bipolar and schizoaffective mania

This pilot study evaluated the efficacy of risperidone therapy in patients with bipolar I or schizoaffective mania who were treatment resistant or treatment intolerant. Patient psychopathology and involuntary movements were evaluated with a variety of scales, and risperidone was administered on an open-label basis. Five of six patients (all bipolar) discontinued risperidone therapy because of adverse drug effects (2 patients), lack of significant drug response and subjective clinical worsening (1 patient), or worsening of manic symptoms (2 patients). One patient with schizoaffective illness improved. Risperidone used without the addition of a mood stabilizer was ineffective in treating pure manic psychosis. In some vulnerable bipolar patients, risperidone monotherapy may have antidepressant activity that could exacerbate mania. If risperidone proves to have antidepressant activity, it may become an important agent in the therapy of patients with depressive symptoms and psychosis.