Treatment of nonpsychotic relatives of patients with schizophrenia: Four case studies

Background: Substantial evidence now shows that the genetic vulnerability t o schizophrenia can be manifested clinically in first-degree relatives of p eople with schizophrenia, even without the full manifestations of the disor der. One pattern of problems observed involves the combination of negative symptoms and neuropsychological deficits. We have investigated whether a lo w dose of a novel antipsychotic medication, risperidone, could attenuate th ese clinical problems in non-psychotic, first-degree relatives, and report here findings from our first 4 cases. Methods: Twelve adults who were first-degree relatives of patients with sch izophrenia were evaluated for the presence of negative symptoms and neurops ychological deficits:(in attention and working memory, long-term verbal mem ory and executive functions). Four subjects who met our predetermined crite ria, and who did not demonstrate medical contraindications, were enrolled i n a 6-week trial of risperidone. Clinical and medical measures were assesse d before, during and after treatment Doses of risperidone started at 0.25 m g and were increased to 1.0-2.0 mg/day. Results: Three subjects showed substantial reductions in negative symptoms, and one subject showed modest reductions. All four subjects showed substan tial improvements on some tests of attention and working memory. Side effec ts of risperidone were temporary and mainly mild Conclusions: These initial findings support two conclusions, First, clinica l deficits in non-psychotic first-degree relatives of people with schizophr enia are identifiable, and to a significant extent, reversible. Second, ris peridone may eventually serve as an effective treatment for people whose li ves are impaired by similar or related problems. (C) 1999 Society of Biolog ical Psychiatry.