A Comparison of Long-Term Outcome in First-Episode Schizophrenia Following Treatment With Risperidone or a Typical Antipsychotic

Background: Most reports assessing the efficacyand tolerability of risperidone have involved patients previouslytreated with typical antipsychotics. Such patients are morelikely to have a greater resistance or intolerance to treatment,thus restricting our interpretation of the impact a new treatmentmight have on the course of schizophrenia and possibly biasingthe results. The present study examines the relativeeffectiveness of risperidone and typical antipsychotics inpatients being treated for their first episode of schizophrenia.

Method: From a cohort of 126 patients, 2 groupsof 19 first-episode DSM-III-R/DSM-IV schizophrenia patientsmatched for age, gender, length of illness, and length oftreatment and treated with either a typical antipsychotic orrisperidone for a minimum of 1 year were compared on a number ofoutcome dimensions during their course of treatment and atfollow-up. Treatment allocation was not random, and patients werejudged to be compliant with medication. Patients treated withtypical antipsychotics were followed up for a statisticallynonsignificantly longer time (mean = 2.7 vs. 1.9 years).

Results: Six patients (31.6%) from the typicalantipsychotic group were admitted to the hospital within thefirst year following the index admission compared with 1 patient(5.3%) in the risperidone group (admitted at month 14). Patientsin the risperidone group showed a statistically significantlylower length of first hospitalization (p < .01), utilizationof inpatient beds during the course of treatment (p < .001),and use of anticholinergic medication (p < .05). There were nostatistically significant differences in symptom levels, eitherduring the course of treatment or at follow-up; in the use ofantidepressant, antianxiety, or mood-stabilizing drugs; or inchanges in living circumstances or employment.

Conclusion: These findings confirm at leastequal long-term efficacy of typical antipsychotics andrisperidone, but a possible advantage for risperidone indecreased service utilization and decreased use ofanticholinergic drugs.