A comparison of long-term outcome in first-episode schizophrenia followingtreatment with risperidone or a typical antipsychotic

Background: Most reports assessing the efficacy and tolerability of risperi done have involved patients previously treated with typical antipsychotics. Such patients are more likely to have a greater resistance or intolerance to treatment, thus restricting our interpretation of the impact a new treat ment might have on the course of schizophrenia and possibly biasing the res ults. The present study examines the relative effectiveness of risperidone and typical antipsychotics in patients being treated for their first episod e of schizophrenia. Method: From a cohort of 126 patients, 2 groups of 19 first-episode DSM-III -R/DSM-IV schizophrenia patients matched for age. gender, length of illness , and length of treatment and treated with either a typical antipsychotic o r risperidone for a minimum of 1 year were compared on a number of outcome dimensions during their course of treatment and at follow-up. Treatment all ocation was not random, and patients were judged to be compliant with medic ation. Patients treated with typical antipsychotics were followed up for a statistically nonsignificantly longer time (mean = 2.7 vs. 1.9 years). Results: Six patients (31.6%) from the typical antipsychotic group were adm itted to the hospital within the first year following the index admission c ompared with 1 patient (5.3%) in the risperidone group (admitted at month 1 4). Patients in the risperidone group showed a statistically significantly lower length of first hospitalization (p < .01). utilization of inpatient b eds during the course of treatment (p < .001). and use of anticholinergic m edication (p < .05). There were no statistically significant differences in symptom levels, either during the course of treatment or at follow-up: in the use of antidepressant, antianxiety, or mood-stabilizing drugs; or in ch anges in living circumstances or employment. Conclusion: These findings confirm at least equal long-term efficacy of typ ical antipsychotics and risperidone, but a possible advantage for risperido ne in decreased service utilization and decreased use of anticholinergic dr ugs.