Very Low-Dose Risperidone in First-Episode Psychosis: A Safe and Effective Way to Initiate Treatment

Patrick D Mcgorry,Susy Harrigan,Peter Burnett,Tim Lambert,John Cocks,Paddy Power

doi:10.1155/2011/631690

Patrick D Mcgorry, Susy Harrigan + Show 4 more

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https://doi.org/10.1155/2011/631690

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Abstract

Patients experiencing a first psychotic episode have high rates of extrapyramidal symptoms (EPSs) when treated with the doses of neuroleptics used in multiepisode or chronic schizophrenia. There is some evidence that lower doses may be equally, if not more, effective but less toxic in this population. Here, we report the results of a biphasic open label trial designed to assess the efficacy, safety, and tolerability of low-dose (2–4 mg/day) risperidone treatment in a group of 96 first-episode nonaffective psychosis patients. At the end of the trial, 62% of patients met the response criteria although approximately 80% had achieved a response at some time during the study. Reports of EPS remained low, and there were no dystonic reactions. We conclude that even at a dose of 2 mg/day, risperidone was highly effective in reducing acute symptomatology in a real world sample of young first-episode psychosis patients.

Highlights

Evidence increasingly suggests that early intervention with antipsychotic medications has a positive effect on treatment response and outcomes in patients with schizophrenia [1]
This was an open label study conducted at the Early Psychosis Prevention and Intervention Centre (EPPIC), part of the Orygen Youth Health Centre for Youth Mental Health in Parkville, Victoria, between January 1996 and June 1997
Previous studies have suggested that very low doses of both typical and atypical neuroleptics may be sufficient to produce a response in acute episodes of schizophrenia, especially in first episode of psychosis (FEP)

Summary

Introduction

Evidence increasingly suggests that early intervention with antipsychotic medications has a positive effect on treatment response and outcomes in patients with schizophrenia [1]. The first five years after onset appears to be the critical window where the greatest functional decline associated with the illness occurs, indicating that initiation of treatment during this period may be beneficial [4]. The progressive functional decline during this period may reflect, among other factors, alterations in brain structure and volume associated with increasing duration of illness in schizophrenia [5,6,7]. Intervention with antipsychotic medications and psychosocial care has been demonstrated to modify these outcomes over time [8, 9]. As well as altering neurotransmitter activity, certain antipsychotic agents have a potentially neuroprotective effect

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