Risperidone use at a state hospital: a clinical audit 2 years after the first wave of risperidone prescriptions.
BACKGROUND
In spite of some inherent limitations, naturalistic data can provide information on populations that have greater heterogeneity than can controlled clinical trials and on functional outcomes that may be especially important in clinical practice. In the present retrospective naturalistic study, we evaluated key clinical outcomes among the first wave of risperidone-treated patients at a state psychiatric hospital.


METHODS
Outcome data were extracted from the charts of 142 patients 2 years after initiation of treatment with risperidone. Their diagnoses included DSM-III-R schizophrenia (57%), schizoaffective disorder (22%), dementia and other organic conditions (7%), bipolar disorder (5%), and other psychiatric disorders (9%).


RESULTS
During the 2-year period, 92 of 142 patients were discharged from the hospital: 61 (43%) were discharged on risperidone treatment and 31 (22%) were discharged on treatment with other drugs. At the time of the study, 50 of 142 patients were still in the hospital: of these, 18 (13%) were still receiving risperidone. The modal maximum daily dose of risperidone was 4.1 mg in patients discharged on risperidone treatment and 7.5 mg in patients still in the hospital. All groups were granted more ward privileges after starting risperidone, the most being granted to patients discharged from the hospital on risperidone treatment (p<.05 versus patients discharged on treatment with other drugs) and those still receiving risperidone in the hospital. Significantly fewer patients discharged on risperidone treatment than on treatment with other drugs were readmitted to the hospital within 2 years after discharge (p<.01).


CONCLUSIONS
Improved privilege levels and a reduced readmission rate indicate that risperidone was an effective antipsychotic agent among a heterogeneous patient population in a state hospital. These factors may be especially important to justify use of this agent in the current fiscal climate.
Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, PA, USA. chengappakn@msx.upmc.edu
K N
KN
Chengappa
S
S
Sheth
J S
JS
Brar
H
H
Parepally
S
S
Marcus
A
A
Gopalani
A
A
Palmer
R W
RW
Baker
N R
NR
Schooler
D000328:Adult; D000978:Antiparkinson Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy; D003024:Clozapine / Q000627:therapeutic use; D003704:Dementia / Q000188:drug therapy; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data; D006783:Hospitals, State / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy*; D010359:Patient Readmission; D011618:Psychotic Disorders / Q000188:drug therapy; D012189:Retrospective Studies; D018967:Risperidone / Q000627:therapeutic use*; D012559:Schizophrenia / Q000188:drug therapy
D000978:Antiparkinson Agents; D014150:Antipsychotic Agents; D003024:Clozapine; D018967:Risperidone