A dose-outcome analysis of risperidone

Background: Although the establishment of appropriate dosage ranges for ant ipsychotics has important ramifications for both short-term treatment and l ong-term therapeutic outcomes, difficulties in dosing persist. Evidence exi sts that initial dosing recommendations for the titration of risperidone to 6 mg/day in 3 days are excessive. This study examines dosage trends of ris peridone and further examines the relationship between dose and outcome by determination of discharge rates among individuals receiving varying doses of the drug. Method: Records of individuals receiving risperidone in Maryland state psyc hiatric facilities from March 1994 through February 1997 (N = 1056) were ex amined. Discharge rates and time to discharge were measured by Kaplan-Meier survival curve analysis. Results: As risperidone use has risen each year since its introduction, mea n doses in both inpatients and discharged patients have steadily declined. Additionally, risperidone doses for discharged patients were significantly lower than those for patients remaining in the hospital. Furthermore, patie nts receiving 2 and 4 mg/day were significantly more likely to be discharge d than those receiving 6 mg/day (log-rank chi(2) = 13.54, df = 2, p = .0011 ), This difference was seen in patients with similar diagnoses, ages, and r acial status. Conclusion: Patients treated with doses less than the 6-mg/day initial dosi ng recommendations have better outcomes in terms of discharge. This finding should encourage clinicians to utilize adequate trials of risperidone aime d at stabilizing patients on doses in the 2- to 4-mg/day range before proce eding to higher doses.