About this Journal Submit a Manuscript Table of Contents
Schizophrenia Research and Treatment
Volume 2011 (2011), Article ID 631690, 10 pages
http://dx.doi.org/10.1155/2011/631690
Research Article

Very Low-Dose Risperidone in First-Episode Psychosis: A Safe and Effective Way to Initiate Treatment

1Orygen Youth Health Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC 3052, Australia
2Lambeth Early Onset Service, Stockwell, London SW97AA, UK

Received 2 March 2010; Revised 21 September 2010; Accepted 6 December 2010

Academic Editor: R. A. Emsley

Copyright © 2011 Patrick D. McGorry et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Linked References

  1. G. Remington, S. Kapur, and R. B. Zipursky, “Pharmacotherapy of first-episode schizophrenia,” British Journal of Psychiatry, vol. 172, no. 33, pp. 66–70, 1998. View at Scopus
  2. M. Marshall, S. Lewis, A. Lockwood, R. Drake, P. Jones, and T. Croudace, “Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review,” Archives of General Psychiatry, vol. 62, no. 9, pp. 975–983, 2005. View at Publisher · View at Google Scholar · View at Scopus
  3. D. O. Perkins, H. Gu, K. Boteva, and J. A. Lieberman, “Relationship between duration of untreated psychosis and outcome in first-episode schizophrenia: a critical review and meta-analysis,” American Journal of Psychiatry, vol. 162, no. 10, pp. 1785–1804, 2005. View at Publisher · View at Google Scholar · View at Scopus
  4. P. D. McGorry, E. Killackey, and A. Yung, “Early intervention in psychosis: concepts, evidence and future directions,” World Psychiatry, vol. 7, no. 3, pp. 148–156, 2008. View at Scopus
  5. W. Cahn, et al., “Brain volume changes in first-episode schizophrenia: a 1-year follow-up study,” Archives of General Psychiatry, vol. 59, no. 11, pp. 1002–1010, 2002. View at Publisher · View at Google Scholar · View at Scopus
  6. B. C. Ho, N. C. Andreasen, P. Nopoulos, S. Arndt, V. Magnotta, and M. Flaum, “Progressive structural brain abnormalities and their relationship to clinical outcome: a longitudinal magnetic resonance imaging study early in schizophrenia,” Archives of General Psychiatry, vol. 60, no. 6, pp. 585–594, 2003. View at Publisher · View at Google Scholar · View at Scopus
  7. D. Velakoulis, S. J. Wood, M. T. H. Wong et al., “Hippocampal and amygdala volumes according to psychosis stage and diagnosis: a magnetic resonance imaging study of chronic schizophrenia, first-episode psychosis, and ultra-high-risk individuals,” Archives of General Psychiatry, vol. 63, no. 2, pp. 139–149, 2006. View at Publisher · View at Google Scholar · View at Scopus
  8. P. McCrone, T. K. J. Craig, P. Power, and P. A. Garety, “Cost-effectiveness of an early intervention service for people with psychosis,” British Journal of Psychiatry, vol. 196, no. 5, pp. 377–382, 2010. View at Publisher · View at Google Scholar · View at Scopus
  9. C. Mihalopoulos, M. Harris, L. Henry, S. Harrigan, and P. McGorry, “Is early intervention in psychosis cost-effective over the long term?” Schizophrenia Bulletin, vol. 35, no. 5, pp. 909–918, 2009. View at Publisher · View at Google Scholar · View at Scopus
  10. J. A. Lieberman, G. D. Tollefson, C. Charles et al., “Antipsychotic drug effects on brain morphology in first-episode psychosis,” Archives of General Psychiatry, vol. 62, no. 4, pp. 361–370, 2005. View at Publisher · View at Google Scholar · View at Scopus
  11. R. R. Girgis, V. A. Diwadkar, J. J. Nutche, J. A. Sweeney, M. S. Keshavan, and A. Y. Hardan, “Risperidone in first-episode psychosis: a longitudinal, exploratory voxel-based morphometric study,” Schizophrenia Research, vol. 82, no. 1, pp. 89–94, 2006. View at Publisher · View at Google Scholar · View at Scopus
  12. P. M. Thompson, G. Bartzokis, K. M. Hayashi et al., “Time-lapse mapping of cortical changes in schizophrenia with different treatments,” Cerebral Cortex, vol. 19, no. 5, pp. 1107–1123, 2009. View at Publisher · View at Google Scholar · View at Scopus
  13. J. P. McEvoy, G. E. Hogarty, and S. Steingard, “Optimal dose of neuroleptic in acute schizophrenia: a controlled study of the neuroleptic threshold and higher haloperidol dose,” Archives of General Psychiatry, vol. 48, no. 8, pp. 739–745, 1991. View at Scopus
  14. J. Zhang-Wong, R. B. Zipursky, M. Beiser, and G. Bean, “Optimal haloperidol dosage in first-episode psychosis,” Canadian Journal of Psychiatry, vol. 44, no. 2, pp. 164–167, 1999. View at Scopus
  15. J. A. Lieberman, G. Tollefson, M. Tohen et al., “Comparative efficacy and safety of atypical and conventional antipsychotic drugs in first-episode psychosis: a randomized, double-blind trial of olanzapine versus haloperidol,” American Journal of Psychiatry, vol. 160, no. 8, pp. 1396–1404, 2003. View at Publisher · View at Google Scholar · View at Scopus
  16. R. A. Emsley, “Risperidone in the treatment of first-episode psychotic patients: a double-blind multicenter study,” Schizophrenia Bulletin, vol. 25, no. 4, pp. 721–729, 1999. View at Scopus
  17. Z. U. Huq, “A trial of low doses of risperidone in the treatment of patients with first-episode schizophrenia, schizophreniform disorder, or schizoaffective disorder,” Journal of Clinical Psychopharmacology, vol. 24, no. 2, pp. 220–224, 2004.
  18. N. Schooler, J. Rabinowitz, M. Davidson et al., “Risperidone and haloperidol in first-episode psychosis: a long-term randomized trial,” American Journal of Psychiatry, vol. 162, no. 5, pp. 947–953, 2005. View at Publisher · View at Google Scholar · View at Scopus
  19. R. S. Kahn, W. W. Fleischhacker, H. Boter et al., “Effectiveness of antipsychotic drugs in first-episode schizophrenia and schizophreniform disorder: an open randomised clinical trial,” The Lancet, vol. 371, no. 9618, pp. 1085–1097, 2008. View at Publisher · View at Google Scholar · View at Scopus
  20. W. W. Fleischhacker, M. A. Oehl, and M. Hummer, “Factors Influencing Compliance in Schizophrenia Patients,” Journal of Clinical Psychiatry, vol. 64, no. 16, supplement, pp. 10–13, 2003. View at Scopus
  21. A. Davies, M. A. Adena, N. A. Keks, S. V. Catts, T. Lambert, and I. Schweitzer, “Risperidone versus haloperidol: I. Meta-analysis of efficacy and safety,” Clinical Therapeutics, vol. 20, no. 1, pp. 58–71, 1998. View at Publisher · View at Google Scholar · View at Scopus
  22. L. C. Kopala, K. P. Good, and W. G. Honer, “Extrapyramidal signs and clinical symptoms in first-episode schizophrenia: response to low-dose risperidone,” Journal of Clinical Psychopharmacology, vol. 17, no. 4, pp. 308–313, 1997. View at Publisher · View at Google Scholar · View at Scopus
  23. M. C. G. Merlo, H. Hofer, W. Gekle et al., “Risperidone, 2 mg/day vs. 4 mg/day, in first-episode, acutely psychotic patients: treatment efficacy and effects on fine motor functioning,” Journal of Clinical Psychiatry, vol. 63, no. 10, pp. 885–891, 2002. View at Scopus
  24. S. Leucht, W. Kissling, and J. McGrath, “Lithium for schizophrenia,” Cochrane Database of Systematic Reviews, no. 3, Article ID CD003834, 2007. View at Scopus
  25. C. Guille, G. S. Sachs, and S. N. Ghaemi, “A naturalistic comparison of clozapine, risperidone, and olanzapine in the treatment of bipolar disorder,” Journal of Clinical Psychiatry, vol. 61, no. 9, pp. 638–642, 2000. View at Scopus
  26. M. Tohen, K. N. Roy Chengappa, T. Suppes et al., “Efficacy of olanzapine in combination with valproate or lithium in the treatment of mania in patients partially nonresponsive to valproate or lithium monotherapy,” Archives of General Psychiatry, vol. 59, no. 1, pp. 62–69, 2002. View at Scopus
  27. K. Chang, A. Karchemskiy, N. Barnea-Goraly, A. Garrett, D. I. Simeonova, and A. Reiss, “Reduced amygdalar gray matter volume in familial pediatric bipolar disorder,” Journal of the American Academy of Child and Adolescent Psychiatry, vol. 44, no. 6, pp. 565–573, 2005. View at Publisher · View at Google Scholar · View at Scopus
  28. R. B. Sassi, P. Brambilla, J. P. Hatch et al., “Reduced left anterior cingulate volumes in untreated bipolar patients,” Biological Psychiatry, vol. 56, no. 7, pp. 467–475, 2004. View at Publisher · View at Google Scholar · View at Scopus
  29. H. K. Manji, G. J. Moore, and G. Chen, “Lithium at 50: have the neuroprotective effects of this unique cation been overlooked?” Biological Psychiatry, vol. 46, no. 7, pp. 929–940, 1999. View at Publisher · View at Google Scholar · View at Scopus
  30. G. E. Berger, T. M. Proffitt, M. McConchie et al., “Ethyl-eicosapentaenoic acid in first-episode psychosis: a randomized, placebo-controlled trial,” Journal of Clinical Psychiatry, vol. 68, no. 12, pp. 1867–1875, 2007. View at Scopus
  31. G. E. Berger, S. J. Wood, R. M. Wellard et al., “Ethyl-eicosapentaenoic acid in first-episode psychosis. A 1H-MRS study,” Neuropsychopharmacology, vol. 33, no. 10, pp. 2467–2473, 2008. View at Publisher · View at Google Scholar · View at Scopus
  32. M. Berk, F. Ng, O. Dean, S. Dodd, and A. I. Bush, “Glutathione: a novel treatment target in psychiatry,” Trends in Pharmacological Sciences, vol. 29, no. 7, pp. 346–351, 2008. View at Publisher · View at Google Scholar · View at Scopus
  33. P. D. McGorry, J. Edwards, C. Mihalopoulos, S. M. Harrigan, and H. J. Jackson, “EPPIC: an evolving system of early detection and optimal management,” Schizophrenia Bulletin, vol. 22, no. 2, pp. 305–326, 1996. View at Scopus
  34. J. E. Overall, D. R. Gorham, and K. Fliege, “The brief psychiatric rating scale,” Psychological Reports, vol. 10, pp. 799–780, 1962.
  35. W. Guy, “Clinical global impression,” in ECDEU Assessment Manual of Psychopharmacology, pp. 217–222, US Department of Health, Education and Welfare, Rockville, Md, USA, 1976.
  36. D. W. Heinrichs, T. E. Hanlon, and W. T. Carpenter, “The Quality of life scale: an instrument for rating the schizophrenic deficit syndrome,” Schizophrenia Bulletin, vol. 10, no. 3, pp. 388–398, 1984. View at Scopus
  37. R. Williams, “Optimal dosing with risperidone: updated recommendations,” Journal of Clinical Psychiatry, vol. 62, no. 4, pp. 282–289, 2001. View at Scopus
  38. M. H. Chakos, D. I. Mayerhoff, A. D. Loebel, J. M. J. Alvir, and J. A. Lieberman, “Incidence and correlates of acute extrapyramidal symptoms in first episode of schizophrenia,” Psychopharmacology Bulletin, vol. 28, no. 1, pp. 81–86, 1992. View at Scopus
  39. J. Lieberman, D. Jody, S. Geisler et al., “Treatment outcome of first episode schizophrenia,” Psychopharmacology Bulletin, vol. 25, no. 1, pp. 92–96, 1989. View at Scopus
  40. A. Caswell, MIMS Annual, MIMS Annual Publications, Sydney, Australia, 2006, Edited by A. Caswell.
  41. D. B. Allison, J. L. Mentore, M. Heo et al., “Antipsychotic-induced weight gain: a comprehensive research synthesis,” American Journal of Psychiatry, vol. 156, no. 11, pp. 1686–1696, 1999. View at Scopus
  42. D. I. Brixner, Q. Said, P. K. Corey-Lisle et al., “Naturalistic impact of second-generation antipsychotics on weight gain,” Annals of Pharmacotherapy, vol. 40, no. 4, pp. 626–632, 2006. View at Publisher · View at Google Scholar · View at Scopus
  43. J. E. Leysen, P. M. F. Janssen, A. A. H. P. Megens, and A. Schotte, “Risperidone: a novel antipsychotic with balanced serotonin-dopamine antagonism, receptor occupancy profile, and pharmacologic activity,” Journal of Clinical Psychiatry, vol. 55, no. 5, supplement, pp. 5–12, 1994. View at Scopus
  44. S. Kapur, “A new framework for investigating antipsychotic action in humans: lessons from PET imaging,” Molecular Psychiatry, vol. 3, no. 2, pp. 135–140, 1998. View at Scopus
  45. S. Kapur, G. Remington, C. Jones et al., “High levels of dopamine D2 receptor occupancy with low-dose haloperidol treatment: a PET study,” American Journal of Psychiatry, vol. 153, no. 7, pp. 948–950, 1996. View at Scopus
  46. S. Nyberg, B. Eriksson, G. Oxenstierna, C. Halldin, and L. Farde, “Suggested minimal effective dose of risperidone based on PET-measured D2 and 5-HT2A receptor occupancy in schizophrenic patients,” American Journal of Psychiatry, vol. 156, no. 6, pp. 869–875, 1999. View at Scopus
  47. S. Kapur, G. Remington, R. B. Zipursky, A. A. Wilson, and S. Houle, “The D2 dopamine receptor occupancy of risperidone and its relationship to extrapyramidal symptoms: a PET study,” Life Sciences, vol. 57, no. 10, pp. PL103–PL107, 1995. View at Publisher · View at Google Scholar · View at Scopus
  48. S. Nyberg, L. Farde, L. Eriksson, C. Halldin, and B. Eriksson, “5-HT and D2 dopamine receptor occupancy in the living human brain. A PET study with risperidone,” Psychopharmacology, vol. 110, no. 3, pp. 265–272, 1993. View at Publisher · View at Google Scholar · View at Scopus
  49. P. D. McGorry, I. B. Hickie, A. R. Yung, C. Pantelis, and H. J. Jackson, “Clinical staging of psychiatric disorders: a heuristic framework for choosing earlier, safer and more effective interventions,” Australian and New Zealand Journal of Psychiatry, vol. 40, no. 8, pp. 616–622, 2006. View at Publisher · View at Google Scholar · View at Scopus