Introduction: Although the use of atypical antipsychotics is the standard of care in the maintenance
treatment of psychosis, most clinicians still rely on conventional neuroleptics to
treat acutely agitated psychotic patients. The objective of this study was to evaluate
the effectiveness and safety of a fast orally disintegrating tablet formulation of
risperidone in the initial treatment of a large sample of very acutely ill psychotic
patients. Methods: In this multi-center, prospective, open-label observational trial, 191 schizophrenic
patients were treated upon admission to hospital with fast orally disintegrating risperidone
tablets for up to seven days. Co-medication was per usual clinical practice and at
physician's discretion. Psychopathology was rated at baseline, 2, 24 and 48 hours
and 4 and 7 days after initiation of therapy. Results: A mean PANSS total score of 114.3±23.4 at baseline reflected a severely exacerbated
patient population. The PANSS total score was significantly reduced to 83.6±26.8 (p<0.0001)
and the CGI from 5.6±0.7 to 4.5±1.1 (p<0.0001) after 7 days. The median time to calmness
was 70 min and the associated PANSS item 4 (excitation) dropped two hours after the
first intake of the study medication from 4.3±1.5 to 3.1±1.5 (p<0.0001). A total of
172 patients (90.1%) out of 191 completed the study. The median risperidone dose was
2 mg/d at the initiation of therapy and 4 mg/d after one week. Conclusion: Oral treatment of acutely exacerbated schizophrenic patients with fast orally disintegrating
risperidone tablets, alone or in combination with benzodiazepines, was associated
with a rapid onset of action and a significant and clinically relevant improvement
of acute symptoms.
References
- 1
Allen MH, Currier GW, Carpenter D, Rose RW, Doherty JP.
Treatment of behavioral emergencies 2005.
J Psychiatr. Pract.
2005;
11
((Suppl 1))
5-108
- 2
Breier A, Meehan K, Birkett M, David S, Ferchland I, Sutton V, Taylor CC, Palmer R,
Dossenbach M, Kiesler G, Brook S, Wright P.
A double-blind, placebo-controlled dose-response comparison of intramuscular olanzapine
and haloperidol in the treatment of acute agitation in schizophrenia.
Arch Gen Psychiatry.
2002;
59
441-448
- 3
Brook S, Luvcey JV, Gunn KP.
Intramuscular ziprasidone compared with intramuscular haloperidol in the treatment
of acute psychosis. Ziprasidone I.M. Study Group.
J Clin Psychiatry.
2000;
61
933-941
- 4
Chue P, Welch R, Binder C.
Acceptability and disintegration rates of orally disintegrating risperidone tablets
in patients with schizophrenia or schizoaffective disorder.
Can J Psychiatry.
2004;
49
701-703
- 5
Currier GW, Simpson GM.
Risperidone liquid concentrate and oral lorazepam versus intramuscular haloperidol
and intramuscular lorazepam for treatment of psychotic agitation.
J Clin Psychiatry.
2001;
62
153-157
- 6
Czobor P, Volavka J, Meibach RC.
Effect of risperidone on hostility in schizophrenia.
J Clin Psychopharmacol.
1995;
15
243-249
- 7
Hillard JR.
Emergency treatment of acute psychosis.
J Clin Psychiatry.
1998;
59
((Suppl 1))
57-60
- 8
Hovens JE, Dries PJ, Melamn CT, Wapenaar RJ, Loonen AJ.
Oral risperidone with lorazepam versus oral zuclopenthixol with lorazepam in the treatment
of acute psychosis in emergency psychiatry: a prospective, comparative, open-label
study.
J Psychopharmacol.
2005;
19
51-57
- 9
Kinon BJ, Hill AL, Liu H, Kollack-Walker S.
Olanzapine orally disintegrating tablets in the treatment of acutely ill non-compliant
patients with schizophrenia.
Int J Neuropsychopharmacol.
2003;
6
97-102
- 10
Lejeune J, Larmo I, Chrzanowski W, Witte R, Karavatos A, Schreiner A, Lex A, Medori R.
Oral risperidone plus oral lorazepam versus standard care with intramuscular conventional
neuroleptics in the initial phase of treating individuals with acute psychosis.
Int Clin Psychopharmacol.
2004;
19
259-269
- 11
Levy RH.
Sedation in acute and chronic agitation.
Pharmacotherapy.
1996;
16
152S-159S
- 12
Raedler TJ, Schreiner A, Naber D, Wiedemann K.
Risperidone in the treatment of acute schizophrenia.
J Clin Psychopharmacol.
2004;
24
335-338
- 13
Van Schaick EA, Lechat P, Remmerie BM, Ko G, Lasseter KC, Mannaert E.
Pharmacokinetic comparison of fast-disintegrating and conventional tablet formulations
of risperidone in healthy volunteers.
Clin Ther.
2003;
25
1687-1699
- 14
Yildiz A, Sachs GS, Turgay A.
Pharmacological management of agitation in emergency settings.
Emerg Med J.
2003;
20
339-346
Correspondence
Claus NormannMD
Department of Psychiatry and Psychotherapy·University of Freiburg
Hauptstr. 5
79104 Freiburg
Germany
Telefon: +49/761/270 6501
Fax: +49/761/270 6619
eMail: claus.normann@uniklinik-Freiburg.de
