Switching from therapy with typical antipsychotic agents to risperidone: Long-term impact on patient outcome

This paper reports the results of a retrospective, open-label study in 31 s chizophrenic patients who had been switched from therapy with a typical ant ipsychotic agent to risperidone, a novel antipsychotic agent, in the course of their treatment in an outpatient/community program. The study was based on both a review of all 31 patients' charts and a structured interview of 26 of the patients. The change to risperidone had been made because of lack of efficacy or intolerance to typical antipsychotic agents after a mean of 3.5 years of therapy. Patients had been maintained on risperidone for a me an of 1.7 years at the time of the review. The impact of switching to rispe ridone was assessed by comparing clinical variables for the patients with t heir own historic control data. The current levels of symptoms, side effect s, and social functioning were also assessed by means of the Interview for Retrospective Assessment of Onset of Schizophrenia and rating scales. Seven ty-one percent and 81% of the patients exhibited a positive response, as me asured by a 30% reduction in psychotic and disorganization syndromes, respe ctively. After the switch, significant declines were noted in service utili zation; the level of psychotic, disorganization, and negative symptom dimen sions; and the use of anticholinergic drugs (P < 0.01 for all). Assessments conducted at the time of the review revealed a low level of psychotic (mea n, 3.5) and disorganization (mean, 3.0) symptoms, a moderate level of negat ive symptoms (mean, 19.5), and a low level of extrapyramidal symptoms (tota l mean parkinsonism score, 6.0). No significant changes were seen in the le vel of employment or in living conditions. Results of this study suggest th at a switch to risperidone therapy because of the inefficacy of typical ant ipsychotic agents or patients' inability to tolerate them may lead to susta ined and significant improvement in a substantial proportion of patients wi th schizophrenia.