EXTRAPYRAMIDAL SIGNS AND CLINICAL SYMPTOMS IN FIRST-EPISODE SCHIZOPHRENIA - RESPONSE TO LOW-DOSE RISPERIDONE

The purpose of this study was to determine the prevalence of extrapyra midal signs or symptoms (EPS) and clinical symptoms in first-episode s chizophrenia, before any treatment, during and after treatment with a novel antipsychotic, risperidone. Twenty-two (17 men; 5 women) patient s were examined using the Extrapyramidal Symptom Rating Scale, Positiv e and Negative Syndrome Scale (PANSS), Clinical Global Impressions-Sev erity of Illness and Improvement, and Global Assessment of Functioning . Three patients (14%) had distinct EPS at baseline, whereas all were free of EPS after treatment with risperidone. On the maximum dose of r isperidone (5-8 mg), 32% of the total sample developed mild akathisia or parkinsonism, both of which diminished with dosage reduction. No cl inically significant EPS were observed in patients receiving 2 to 4 mg of risperidone. Analysis of symptom response of the lower (2-4 mg) ve rsus the higher (5-8 mg) doses of risperidone resulted in superior out come in the 2- to 4-mg group for all three symptom clusters of the PAN SS, In addition, 91% of the low-dose group achieved a 20% or greater r eduction in total PANSS score compared with 27% for the high-dose grou p. These findings have clinical relevance directed at the early and lo nger-term treatment of schizophrenia.