RISPERIDONE IN THE MANAGEMENT OF VIOLENT, TREATMENT-RESISTANT SCHIZOPHRENICS HOSPITALIZED IN A MAXIMUM SECURITY FORENSIC FACILITY

This study examines the effectiveness of risperidone compared with tra ditional neuroleptic medications in the areas of clinical functioning and aggressive behaviors in a sample of inpatients diagnosed with chro nic schizophrenia. Similar to the methodology of Menditto at al. (Psyc hiatr Serv 47:46-51, 1996), two groups of 10 patients were selected fr om those being treated in a comprehensive psychosocial rehabilitation program. Group 1 subjects were placed on risperidone at various times during their treatment. Group 2 subjects, who were matched with Group 1 subjects on pre-study levels of clinical functioning as measured by the Time-Sample Behavioral Checklist (TSBC), remained on traditional n euroleptics throughout the study period. For each subject, scores on s ix TSBC subscales were examined at four time points; data were analyze d with repeated-measures multivariate analyses of variance and univari ate analyses of variance. Frequency counts of aggressive behaviors (th reats and assaults) were compiled into two six-month time periods and analyzed with nonparametric techniques. The risperidone group did not differ from the traditional neuroleptic group on measures of clinical functioning and aggressiveness measured over time. Both groups evidenc ed improvements in bizarre motor behaviors over the study period. The risperidone group evidenced some deterioration in measures of appropri ate interpersonal interaction over time. No differences in aggressive behaviors were noted for either group. The study concludes that for fo rensic patients with chronic schizophrenia, risperidone failed to prod uce therapeutic effects in overall clinical functioning and aggressive behaviors that were significantly different from traditional neurolep tics. Descriptive comparisons are made between the receptor-binding pr ofiles and clinical effectiveness of risperidone and clozapine in an a ttempt to explain these findings.