A Naturalistic Study of Risperidone Treatment Outcome Using Prognosis-Adjusted Discharge Rates in New York State Inpatients
J Clin Psychiatry 2002;63(7):585-590
© Copyright 2015 Physicians Postgraduate Press, Inc.
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Background: Information concerning the
effectiveness of newer atypical antipsychotics is derived largely from controlled clinical trials
of relatively short duration. Limited information
is available concerning naturalistic outcome of patients selected for clinical treatment with
atypical antipsychotics. This study evaluates 1-year
discharge rates among all patients treated with
risperidone within the New York State inpatient
psychiatric hospital system during the calendar
years 1994 and 1995 ("period of interest") relative
to patients treated with all other antipsychotic
Method: Data from the Integrated
Research Database at Nathan Kline Institute
(Orangeburg, N.Y.) were used. This database maintains
complete treatment records for all inpatients
within the New York State psychiatric inpatient
system along with demographic, diagnostic,
admission, and discharge information. Patients were
identified at admission or first change in
antipsychotic during the period of interest, and 1-year
outcome was determined.
Results: 2198 risperidone-treated
patients were identified versus 3259 treated with
other antipsychotics. Length of hospitalization prior
to treatment initiation was the primary predictor
of discharge rate for both risperidone and control groups. When adjustment was made for
between-group difference in prognosis
(dischargeability), patients treated with risperidone within 30 days
of admission were less likely to be discharged
than those treated with all other agents (including
clozapine), whereas risperidone was more effective in patients who had been hospitalized for 90
days or more prior to switch from another antipsychotic to risperidone.
Conclusion: When database information
is utilized to evaluate treatment effectiveness,
adjustment must be made for a priori differences
in prognosis or dischargeability. With appropriate methodology, database studies may
indicate which patient groups are most likely to
benefit from newer atypical antipsychotic agents.