Risperidone in first-episode schizophrenia: Improvement in symptoms and pre-existing extrapyramidal signs

This study extends earlier findings that a significant proportion of neuroleptic-naive individuals with first-episode schizophrenia have extrapyramidal movement abnormalities, and that risperidone is highly effective in controlling psychotic symptoms and abnormal movements. Forty- one neuroleptic-naive patients with DSM-IV schizophrenia or schizophreniform disorder were assessed for abnormal movements using the Extrapyramidal Symptom Rating Scale (ESRS) before and during treatment with risperidone (0.5 mg/day gradually increasing over 2-3 weeks to 1-8 mg/day as needed). The mean dose required was 3.9 mg/day. Psychopathology was assessed using the PANSS (5 factors), the GAF and the CGI. Movement abnormalities occurred in 28% of the sample before treatment, and those patients had worse baseline PANSS negative sub-scale scores than those without such abnormalities. Patients responded with significant improvements in all PANSS sub-scale scores (positive, negative, excited, anxious/depressed and cognitive), in GAF and CGI scores. ESRS scores of those with pre-existing movement disorders fell during treatment and none developed drug-induced extrapyramidal side-effects. Overall clinical improvement was no different for those with and those without pre-existing movement disorders. It is concluded that risperidone monotherapy can improve pre-existing movement disorders and is highly effective in improving psychopathology in first-episode schizophrenia patients.