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Query: UMLS:C0036341 (schizophrenia)
 60,220 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The recent introduction of several antipsychotic medications has raised expectations for better pharmacological management of schizophrenia. Although conventional and new neuroleptics (Risperidone, Olanzapine, Seroquel and soon to be released Ziprasidone) are generally comparable in terms of efficacy; the new antipsychotic medications possess a better side-effects profile and are overall, much better tolerated. The reintroduction of Clozapine as an effective antipsychotic for treatment refractoriness has also improved management for a segment of the schizophrenic population who failed to respond adequately to other antipsychotic medications. Such increased benefits from new antipsychotic medications come with a higher acquisition cost that has somewhat strained the historically low psychiatric budgets. The question then was whether the expected benefits of the new antipsychotics can offset the high cost of these medications in the long-term. In that context, quality of life assessment has provided a tool for the comparative analysis of new and conventional antipsychotic medications, particularly regarding their impact on functional status and satisfaction. In a recently concluded study, we demonstrated that the new antipsychotic medications are subjectively much better tolerated and have a more favourable impact on quality of life compared with conventional neuroleptics. The ultimate question is whether such favourable benefits can translate in the future into better compliance with medications and improved long-term outcomes.
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PMID:Quality of life and new antipsychotics in schizophrenia. Are patients better off? 1068 10

The overall effectiveness of traditional antipsychotics has been hindered by their extrapyramidal side effects, which contribute to noncompliance and relapse in patients with schizophrenia. The side effects associated with traditional antipsychotic treatment are generally minimal in patients who take risperidone, a combined 5-HT2/D2 antagonist, but the literature is sparse on adverse events among the newer atypical antipsychotics. Risperidone is associated with relatively few motor side effects compared with the traditional antipsychotics, and weight gain is less likely with risperidone than with either clozapine or olanzapine. While increased prolactin levels have been reported in patients taking risperidone, little correlation has been found between prolactin levels and adverse events. As antipsychotic treatment options expand to include the new agents, it is important for clinicians to anticipate side effects and to query patients about specific adverse events.
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PMID:Risperidone side effects. 1081 Dec 39

The authors proposed to develop an evidence-based guideline relevant to drug use for treatment-resistant schizophrenia (TRS), which will be called "Guideline for the Pharmacotherapy of Treatment-Resistant Schizophrenia or PTRS Guideline". The authors performed a MEDLINE search (between 1966 and December 1998) and classified the study designs of those trials by using the system proposed by the Agency for Health Care Policy and Research (AHCPR). The levels of evidence were graded and recommendations were made by the use of a system modified from that of the AHCPR. One hundred and sixty-three articles met the inclusion criteria for the review. For a schizophrenic patient who does not respond to a classical antipsychotic, physicians should switch from the first classical antipsychotic to the second one, which belongs to a different class. A schizophrenic patient who does not respond to at least two adequate trials of classical antipsychotics should be classified as a TRS patient. Clozapine should be considered as a first-line treatment for TRS. Risperidone should be considered in a TRS patient who refuses to have regular blood monitoring or has contraindication for clozapine. Physicians should use this guideline to accompany others that suggest the overview of treatment for schizophrenia. Appropriate application and the limitations of the guideline are also discussed.
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PMID:Guideline for the pharmacotherapy of treatment-resistant schizophrenia. Royal College of Psychiatrists of Thailand. 1093 83

Two cases of tardive dystonia are reported. The first case was an 18-year-old schizophrenic woman suffering from parkinsonism and hypotension induced by antipsychotic drugs. Risperidone (4 mg/day) was added to her drug regimen and after increasing the dosage to 6 mg/day, she began to exhibit retrocollis. The second case was a 61-year-old woman who had schizophrenia and tardive dyskinesia. After replacing chlorpromazine (75 mg/day) with risperidone (4 mg/day), she began to exhibit retrocollis. The retrocollis in both cases was considered to be tardive dystonia provoked by risperidone administered concomitantly with other antipsychotics. Risperidone is reported to produce few extrapyramidal symptoms, but these cases suggested that changing from other drugs to risperidone, or rapidly increasing risperidone dosage, may provoke tardive syndrome.
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PMID:Tardive dystonia provoked by concomitantly administered risperidone. 1099 70

Risperidone (Risperdal, Janssen Pharmaceutica) is a second generation antipsychotic (SGA) for the treatment of schizophrenia and other psychotic disorders. It is a potent antagonist of serotonin-2 (5-HT2) and dopamine-2 (D2) receptors in the brain. In comparison to conventional antipsychotics, risperidone demonstrates superior efficacy against the positive and negative symptoms of schizophrenia and a decreased occurrence of extrapyramidal side effects (EPS). Risperidone causes less weight gain than other marketed SGAs, but can increase prolactin levels and cause EPS in a dose-related manner. In a variety of pharmacoeconomic analyses, it has proven to be a cost-effective addition to the antipsychotic armamentarium. As the first SGA available for front line use, risperidone has established a new standard of care for the treatment of individuals with psychotic disorders.
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PMID:Pharmacology and clinical experience with risperidone. 1124 77

The pharmacoeconomic evaluation of atypical antipsychotics for the treatment of schizophrenia involves documentation of clinical effectiveness, quality of life and medical cost outcomes. The findings of pharmacoeconomic studies assist psychiatrists and mental healthcare decision-makers in identifying therapies that provide the greatest benefit to patients at the most acceptable cost. The cost-effectiveness of the newer atypical antipsychotics has been examined using non-controlled cohort studies (either retrospective or prospective), modelling studies or randomised clinical trials. The evidence, from a variety of studies, indicates that clozapine is a cost-effective treatment for neuroleptic refractory schizophrenia. Risperidone and olanzapine may be cost neutral, or at best slightly cost saving, compared with conventional antipsychotics, although they do improve patient clinical effectiveness and quality of life outcomes. There is too little data on pharmacoeconomic outcomes for sertindole and quetiapine to make any conclusions about their cost-effectiveness in treating schizophrenia.
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PMID:The new atypical antipsychotics: a review of pharmacoeconomic studies. 1124 46

Schizophrenia is associated with cognitive deficits for which treatments remain elusive. The effects of risperidone (an antipsychotic differing in some of its pharmacological properties from typical agents) on cognitive deficits have not been extensively investigated. Mismatch negativity (MMN), N2 and P3 are cognitive event-related potentials that index preattentive (MMN) and attention-dependent information processing (N2, P3) and provide a measure of cognitive deficits in schizophrenia. The effects of risperidone treatment on MMN, N2 and P3 generation in chronic schizophrenic patients were investigated in an open- label, uncontrolled study. Risperidone treatment significantly reduced psychotic symptoms. It was associated with a decrease of peak latencies, particularly pronounced for P3. However, it did not significantly affect abnormal MMNor P3 amplitudes. The results suggest an effect of risperidone on processing speed, particularly in attention-dependent tasks. These results are in agreement with findings in recent studies on the cognitive effects of risperidone.
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PMID:Effects of risperidone on auditory event-related potentials in schizophrenia. 1128 46

Risperidone, an antipsychotic agent with combined serotonin (5-HT2A) and dopamine (D2) receptor-blocking properties, is associated with fewer extrapyramidal side effects in adults than conventional neuroleptics. Approved in 1993 for the treatment of schizophrenia, recent studies have highlighted its potential in other conditions, such as the management of behavioral disturbances. This phase II, double-blind, placebo-controlled study evaluated the efficacy and tolerability of risperidone in the treatment of persistent behavioral disturbances in children with borderline intellectual functioning. Thirteen patients (6-14 years) with low IQ (66-85) were enrolled in and completed the 4-week study. Risperidone, in daily doses of > or = 0.01 mg/kg (mean dose at treatment endpoint = 0.05 mg/kg; mean total dose = 1.2 mg/day), was significantly more effective than placebo in improving Aberrant Behavioral Checklist (ABC) symptom cluster scores for irritation (p < 0.05) and hyperactivity (p < 0.01), Clinical Global Impression score (p < 0.05), the Visual Analogue Scale score for individual target symptom (p < 0.001), and Personal Assessment Checklist scores for social relationships (p < 0.05) and occupational attitudes (p < 0.05). In addition, the improvement in total ABC score in the risperidone-treated group was clinically relevant (65% improvement vs. baseline), whereas the placebo-treated patients only improved 7% versus baseline. There was no difference between risperidone- and placebo-treated groups with respect to the occurrence of extrapyramidal side effects, and risperidone was well tolerated. In conclusion, short-term risperidone treatment was well tolerated and significantly more effective than placebo in controlling behavioral disturbances in children with low IQ.
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PMID:Risperidone in the treatment of behavioral disturbances in children and adolescents with borderline intellectual functioning: a double-blind, placebo-controlled pilot trial. 1132 45

The Risperidone Olanzapine Drug Outcomes studies in Schizophrenia (RODOS) programme was an international series of naturalistic studies designed to evaluate drug use patterns and outcomes. RODOS consisted of retrospective chart reviews performed in patients who had been admitted to hospital and treated in 61 centres in nine countries. The analysed population consisted of 1901 patients with diagnoses of schizophrenia or schizoaffective disorder. The mean (SD) daily doses of risperidone and olanzapine were 5.3 (2.6) mg/day and 14.5 (5.1) mg/day, respectively. Patients treated with risperidone stayed an average of 3.8 days less in hospital compared to those receiving olanzapine (time to discharge was 43.6 days versus 47.4 days, respectively; P = 0.004). Risperidone was rated as effective in significantly more patients than olanzapine (84% versus 79%; P = 0.01). The time to onset of efficacy was significantly shorter with risperidone than with olanzapine (P < 0.001). The numbers of adverse events in the two treatment groups were not significantly different (13% risperidone, 11% olanzapine; P = 0.1). Correcting for small but statistically significant baseline differences between the two treatment groups did not produce a substantive change in the magnitude or significance of any outcome parameter. In conclusion, the clinical outcomes reported by RODOS suggest that risperidone may be more effective as a first-line therapy drug for schizophrenia than olanzapine.
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PMID:Risperidone olanzapine drug outcomes studies in schizophrenia (RODOS): efficacy and tolerability results of an international naturalistic study. 1145 31

We report the health economic data from the Risperidone Olanzapine Drug Outcomes studies in Schizophrenia (RODOS) programme. Details of the efficacy and tolerability data from RODOS are available in a companion paper. The population analysed during RODOS consisted of 1901 patients with diagnoses of schizophrenia or schizoaffective disorder. The mean +/- SD daily dose of olanzapine treatment was 14.5 +/- 5.1 mg compared to 5.3 +/- 2.6 mg for risperidone. Use of concomitant neuroleptics (risperidone, 65%; olanzapine, 62%; P = 0.2) and other concomitant drugs (risperidone, 76%; olanzapine, 73%; P = 0.2) was similar in both groups. The mean +/- SD total costs of all inpatient drugs was significantly (P < 0.001) higher for olanzapine (US$ 297.5 +/- 305.1) than risperidone (US$159.9 +/- 183.3). Although this difference in the average total costs in part reflects the longer treatment duration for olanzapine compared to risperidone (34 days versus 31 days), the cost difference remained when looking at costs on a daily basis. The mean +/- SD daily cost of all inpatient drugs was also significantly (P < 0.001) higher for olanzapine (US$7.7 +/- 4.0) than for risperidone (US$ 4.6 +/- 2.9). These findings were very consistent across all nine countries. The results from RODOS suggest that treatment costs are significantly higher with olanzapine than with risperidone without any clinical benefit to offset this.
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PMID:Risperidone olanzapine drug outcomes studies in schizophrenia (RODOS): health economic results of an international naturalistic study. 1145 32


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