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Risperidone for Preventing Relapse in Schizophrenics

Most patients with schizophrenia undergo psychotic relapses and require rehospitalization for stabilization and reinitiation or adjustment of medication, despite increased patient education and more consistent follow-up. A potential solution may be the new class of atypical antipsychotic medications, which are associated with more favorable side-effect profiles and greater reductions in negative psychotic symptoms than are standard neuroleptics. However, long-term effects of atypical antipsychotics are uncertain. In a multisite, double-blind, randomized study, investigators compared treatment with haloperidol (mean daily dose, 11.7 mg) with that of the newer antipsychotic risperidone (mean daily dose, 4.9 mg) in 397 stable adult schizophrenic patients. Patients were treated for 1 year, and dosages were adjusted to optimize clinical effects and minimize side effects.

Compliance was over 95% in both groups. Risk of relapse (defined as hospitalization, suicide or homicide ideation, 25% worsening in symptoms, or behavioral deterioration) was significantly greater in the haloperidol group than in the risperidone group (60% vs. 34%). Haloperidol was associated with 1.5 times greater discontinuation of treatment than risperidone, largely due to relapses. Compared with the haloperidol group, the risperidone group had significantly greater mean reductions in extrapyramidal symptoms and positive and negative symptoms, but experienced weight gain (mean, 5 lbs. vs. 2-lb loss with haloperidol).

Comment: These findings show clear long-term benefits associated with risperidone; it has greater efficacy and tolerability and lower relapse rates than haloperidol. The stability and high compliance rate of this particular patient group make it unclear whether these effects would extend to less stable and compliant patients. However, development of a depot risperidone preparation may enable poorly compliant patients to obtain these benefits in the future.

— Peter Roy-Byrne, MD

Published in Journal Watch Psychiatry January 24, 2002

Citation(s):

Csernansky JG et al. A comparison of risperidone and haloperidol for the prevention of relapse in patients with schizophrenia. N Engl J Med 2002 Jan 3; 346:16-22.

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