Risperidone dosing pattern and clinical outcome in psychosis: an analysis of 1713 cases.
BACKGROUND
In treating patients with psychosis, practicing clinicians use various dosing strategies of antipsychotic medications, including risperidone. To evaluate the outcome of different risperidone dosing strategies in clinical practice, we undertook a large, prospective, naturalistic study in which daily dosage was determined freely by local standards of care.


METHODS
In a 6-week trial between December 2000 and January 2002, 1713 patients with DSM-IV schizophrenia and related psychoses were treated with risperidone, with the dose, daily changes in dose, and weekly changes in Brief Psychiatric Rating Scale score documented. Cluster analysis was performed to identify homogeneous dosing patterns among the heterogeneous total population.


RESULTS
Of the 6 dosing patterns identified by cluster analysis, a 2-week titration cluster, with a starting dose of 1.8 mg/day titrated to a maximum dose of 4.7 mg/day at day 14, and a 1-week titration cluster, with a starting dose of 2.6 mg/day titrated to a maximum dose of 5.4 mg/day at day 7, showed superior clinical outcomes compared with the other clusters, in which titrations were slower and higher.


CONCLUSIONS
Our results indicate that the current consensus regarding risperidone dosing is appropriate for clinical practice, whereas a slower titration schedule does not guarantee a better clinical outcome, thus emphasizing the need for appropriate early titration.
Kim
Chang Yoon
CY
Department of Psychiatry, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. cykim@amc.seoul.kr
Shin
Yong-Wook
YW
Joo
Yeon Ho
YH
Hong
Jin-Pyo
JP
Lee
Gun Hee
GH
Choi
Sung-Ku
SK
D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D010054:Brief Psychiatric Rating Scale / Q000706:statistics & numerical data; D016000:Cluster Analysis; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D010352:Patient Dropouts; D017410:Practice Guidelines as Topic / Q000592:standards; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011618:Psychotic Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D018967:Risperidone / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D012559:Schizophrenia / Q000175:diagnosis / Q000188:drug therapy; D012565:Schizophrenic Psychology; D016896:Treatment Outcome
D014150:Antipsychotic Agents; D018967:Risperidone