RISPERIDONE IN THE TREATMENT OF AFFECTIVE-ILLNESS AND OBSESSIVE-COMPULSIVE DISORDER

Background: Risperidone is a new-generation atypical antipsychotic age nt with potent dopaminergic and serotonergic antagonist activity. Comp ared with traditional dopamine-blocking neuroleptics, risperidone is m ore effective in treating negative symptoms of schizophrenia and may b e less likely to cause extrapyramidal symptoms or tardive dyskinesia, Although risperidone is marketed for the treatment of schizophrenia, i ts novel psychopharmacologic effects and potentially mild side effect profile suggest the possibility of other therapeutic applications. An open prospective study was undertaken to determine whether risperidone might diminish psychosis, severe agitation, or rapid cycling in patie nts having acute and chronic primary affective illnesses (bipolar and major depressive disorder) and to document response characteristics an d side effects, Additionally, a small number of patients with refracto ry obsessive-compulsive disorder (OCD) without comorbid tic or delusio nal disorders were given open trials of risperidone added to their med ication. Method: Outpatients who fulfilled DSM-IV criteria for bipolar I, bipolar II, or major depressive disorder and suffered from psychos is or agitation associated with their illness (N = 20) and those who h ad treatment-refractory DSM-IV OCD (N = 5) were started on open trials of risperidone at daily doses of 1 to 1.5 mg. Doses were adjusted upw ards to a maximum of 6 mg depending on clinical response. Results: Sev enteen (85%) of 20 patients (13 bipolar, 4 major depressive disorder) showed complete or partial improvement after treatment with risperidon e doses ranging from 1 to 6 mg/day (mean = 3.5 mg). Beneficial effects included decreases in agitation, psychosis, sleep disturbance, and ra pid cycling. Four patients (20%) discontinued risperidone because of i ntolerable side effects. Five patients with refractory OCD also showed significant symptomatic improvement after the addition of risperidone . Conclusion: The findings suggest that (1) risperidone may be useful in the acute/p.r.n. and chronic treatment of psychosis, agitation, and cycling accompanying affective illness, and (2) risperidone may be us eful in augmenting pharmacologic response in OCD.