Risperidone in the early treatment of first-episode psychosis: a two-year follow-up study

The main goals of any antipsychotic pharmacological treatment are the improvement of negative, positive, behavioral, affective and cognitive symptoms related to psychotic disorders, a good side-effects profile and again an improvement in patients quality of life and social - environmental relationships. The development of new atypical antipsychotic drugs has opened new therapeutical bias. Nevertheless only a few clinical studies have been developed studying new atypical antipsychotic role on first psychotic episodes. We developed an open, observational, multicenter and prospective study in order to evaluate effectiveness, tolerability and security of early treatment with risperidone in patients affected by a first psychotic episode (DSM IV diagnostic criteria) and the long-term effect of this treatment on the clinical evolution of these patients. We recruited 436 patients (age 18-65) who had never before received any antipsychotic drug. The most prevalent diagnosis was schizophrenia and other psychotic disorders no substance abuse related (90.6%). The average dosage of risperidone used during this study was 5.12 mg/d and most of the patients remained on risperidone monotherapy. We observed a statistically significant improvement in psychopathological scale PANSS (total; positive, negative and general subescales), Global Activity Scale (EEAG) and Clinical Global Impression Scale (CGI) scores from first month treatment on. This improvement was maintained during the two-year follow up period. We also observed an improvement in Young Mania Scale and Hamilton Depression Scale scores sustained from first month up to the end of the study. The number of patients hospitalized importantly decreased and most of them (95.9%) were ambulatory patients at the end of the study. We also observed a decrease on UKU neurological side-effects scale scores (including parkinsonism) from sixth month up to the end of the study and from basal to final evaluation. Other side effects related were amenorrhea (2.1%) and weight gain (1.6%). Investigators' opinion about risperidone efficacy and tolerability was good or very good in 84.4% and 91.6% respectively. This study concludes that risperidone is an effective, well tolerated an secure antipsychotic drug in the treatment of patients with a first psychotic episode, and in our opinion is a first rank therapeutical alternative in these kind of patients.