Risperidone Dosing Pattern and Clinical Outcome in Psychosis: An Analysis of 1713 Cases
J Clin Psychiatry 2005;66(7):887-893
© Copyright 2014 Physicians Postgraduate Press, Inc.
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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
Method: 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
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.
Conclusion: 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.