Switching from therapy with typical antipsychotic agents to risperidone: Long-term impact on patient outcome

Malla, Ashok; Norman, Ross; Kotteda, Vinod; Zirul, Sandra

doi:10.1016/s0149-2918(99)80003-4

Cited by 9 publications

(9 citation statements)

References 21 publications

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“…Symptom reduction in thought disturbance only just failed to reach statistical significance, suggesting that switching from conventional drugs to risperidone may be more effective in reducing negative symptoms rather than positive symptoms in the present sample. These findings are generally consistent with previous studies of switching from conventional drugs to risperidone 10–16 . Because the dosage of antipsychotics did not change significantly after switching (Table 1), this symptom reduction cannot be ascribed to change in dosage.…”

Section: Discussionsupporting

confidence: 91%

“…If atypical drugs are superior to their conventional counterparts, then switching from the latter to the former would result in better clinical outcomes. With respect to risperidone, in particular, switching seems to improve overall symptom severity, psychotic symptoms, disorganization, negative symptoms, depressive symptoms, 10–16 memory functions, 17 subjective sleep quality, 18 and quality of life (QOL), 16 and to reduce EPS or antiparkinsonian medication 10–12,15 , 16 . However, there are some drawbacks: switching from conventional antipsychotics to risperidone had no effect on QOL, 14 level of employment, standard of living, 13 or antiparkinsonian medication use 19 …”

Section: Introductionmentioning

confidence: 99%

“…With respect to risperidone, in particular, switching seems to improve overall symptom severity, psychotic symptoms, disorganization, negative symptoms, depressive symptoms, [10][11][12][13][14][15][16] memory functions, 17 subjective sleep quality, 18 and quality of life (QOL), 16 and to reduce EPS or antiparkinsonian medication. [10][11][12]15,16 However, there are some drawbacks: switching from conventional antipsychotics to risperidone had no effect on QOL, 14 level of employment, standard of living, 13 or antiparkinsonian medication use. 19 Nonetheless, the majority of studies have provided evidence supporting the superiority of new atypical drugs to conventional antipsychotics; furthermore, atypical antipsychotics, such as risperidone, are rapidly evolving to become the standard in the pharmacotherapy of schizophrenia.…”

Section: Introductionmentioning

confidence: 99%

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Effects of switching from conventional antipsychotics to risperidone in Japanese patients with chronic schizophrenia

Nakanishi

Murray²,

Nojima

et al. 2006

Psychiatry Clin Neurosci

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Atypical antipsychotics are rapidly evolving to become the standard pharmacotherapy in schizophrenia; however, the trend of switching to such drugs is not necessarily progressing quickly in East Asia. This might be due to the scarcity of evidence for the efficacy of switching from conventional to atypical antipsychotics, which prompted the authors to examine effects of switching from conventional antipsychotics to an atypical drug, risperidone, in Japanese patients. Fifty patients with chronic schizophrenia completed the study in which combination therapy with other antipsychotics was allowed if monotherapy with risperidone was not tolerated. Symptoms were assessed with the brief psychiatric rating scale (BPRS). Switching to monotherapy was achieved in 34 patients (68%). The number of antipsychotics prescribed to each patient was reduced (from 2.1 to 1.4 drugs; P < 0.001) and the use of antiparkinsonian drugs decreased (P < 0.001). The mean BPRS score was also reduced 6 months after initiation of the switch (P < 0.001). Failure in switching to monotherapy was associated with higher dosage of antipsychotics at baseline. Switching from conventional antipsychotics to risperidone reduced schizophrenia symptoms, antiparkinsonian medication, and polypharmacy. However, a portion of patients, particularly those who receive an excessive dosage of antipsychotics, might not tolerate such switching.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effects of switching from conventional antipsychotics to risperidone in Japanese patients with chronic schizophrenia

Nakanishi

Murray²,

Nojima

et al. 2006

Psychiatry Clin Neurosci

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“…Three of these studies showed that switching to olanzapine (Costa e Silva et al, 2001;Soholm and Lublin, 2003), risperidone (Soholm and Lublin, 2003) or quetiapine (Emsley et al, 2000) resulted in significant reductions in EPS while the fourth study, a retrospective, open-label study (Malla et al, 1999;Emsley et al, 2000;Soholm and Lublin, 2003) in patients who switched to risperidone from previous conventional antipsychotic therapy, showed that there were improvements in all dimensions of psychopathology, though half of the patients continued to experience mild to moderate EPS (Malla et al, 1999). Furthermore, in a double-blind study of quetiapine versus haloperidol in 288 patients with a history of only partial response to conventional antipsychotics, significantly more patients receiving quetiapine than haloperidol exhibited a clinical response (defined as a further !…”

Section: Discussionmentioning

confidence: 99%

Efficacy and tolerability of quetiapine in patients with schizophrenia who switched from haloperidol, olanzapine or risperidone

Larmo¹,

Nayer

Windhager³

et al. 2005

Human Psychopharmacology

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A post hoc analysis of the SPECTRUM trial was carried out to evaluate whether the improvements in efficacy and tolerability gained on switching to quetiapine occurred consistently for patients previously treated with either: haloperidol (n = 43); olanzapine (n = 66); or risperidone (n = 55) monotherapy. Patients were initiated with quetiapine to 400 mg/day over 7 days, and then flexibly dosed (300-750 mg/day) for 11 weeks. The mean (SD) modal dose of quetiapine was 501 (138) mg/day in the haloperidol subgroup, 472 (147) mg/day in the olanzapine subgroup and 485 (141) mg/day in the risperidone subgroup at the study endpoint. Switching to quetiapine induced significant improvements from baseline in PANSS scores, with least square mean changes in total scores of -32.5, -15.4, and -18.5 for patients previously treated with haloperidol, olanzapine and risperidone, respectively, (all p < 0.001 vs baseline). Significant improvements were also noted in CDSS scores, particularly for patients clinically depressed at baseline (all p < 0.001 vs baseline). There were significant reductions in EPS on the SAS and BAS for all subgroups (all p < 0.001 vs baseline). Switching to quetiapine produced efficacy and tolerability benefits regardless of whether their previous antipsychotic was haloperidol, olanzapine or risperidone.

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“…It is also unclear whether these agents significantly affect longterm outcome. Malla et al [32] looked retrospectively at the long-term (1.5 year) impact of switching from conventional antipsychotics to risperidone in a group of 31 outpatients. Although patients had low levels of positive symptoms and disorganization, they continued to show moderate levels of negative symptoms and were unchanged in terms of level of employment and living conditions.…”

Section: Summary Of Risperidone and Olanzapine Treatmentmentioning

confidence: 99%

Treatment of negative and cognitive symptoms

Javitt

1999

Curr Psychiatry Rep

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Persistent negative symptoms and cognitive dysfunction are a major cause of chronic disability in schizophrenia. Atypical antipsychotics such as clozapine, risperidone, and olanzapine induce significantly greater improvement in negative symptoms than that which is obtained with conventional agents. However, it remains unclear whether these agents treat core negative symptoms of schizophrenia, or simply induce less secondary psychopathology. A second approach for treatment of persistent negative symptoms is the use of N-methyl-d-aspartate (NMDA) receptor-stimulating agents, such as glycine, d-serine or d-cycloserine. These agents, when added to conventional or atypical antipsychotics, may induce significant additional reduction in both negative and cognitive symptoms.

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Switching from therapy with typical antipsychotic agents to risperidone: Long-term impact on patient outcome

Cited by 9 publications

References 21 publications

Effects of switching from conventional antipsychotics to risperidone in Japanese patients with chronic schizophrenia

Effects of switching from conventional antipsychotics to risperidone in Japanese patients with chronic schizophrenia

Efficacy and tolerability of quetiapine in patients with schizophrenia who switched from haloperidol, olanzapine or risperidone

Treatment of negative and cognitive symptoms

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