Risperidone Dosing Pattern and Clinical Outcome in Psychosis: An Analysis of 1713 Cases

Chang Yoon Kim, M.D., Ph.D.; Yong-Wook Shin, M.D.; Yeon Ho Joo, M.D., Ph.D.; Jin-Pyo Hong, M.D., Ph.D.; Gun Hee Lee, Ph.D.; and Sung-Ku Choi, M.D.

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.

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 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.

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.

(J Clin Psychiatry 2005;66:887-893)

Received Feb. 16, 2004; accepted Dec. 14, 2004. From the Department of Psychiatry, University of Ulsan College of Medicine, Asan Medical Center (Drs. Kim, Shin, Joo, and Hong); Sogang University College of Business Administration (Dr. Lee); and Janssen Korea Medical Department of Janssen Korea (Dr. Choi), Seoul, Korea.

Supported by a grant from Janssen Korea Limited, Seoul, Korea (RIS-KOR-026).

Drs. Kim, Shin, Joo, Hong, Lee, and Choi report no other financial relationships relevant to the subject of this article.

Corresponding author and reprints: Chang Yoon Kim, M.D., Ph.D., Department of Psychiatry, University of Ulsan College of Medicine, 388-1 Pungnap-2dong, Songpa-gu, Seoul, Korea 138-736 (e-mail: cykim@amc.seoul.kr).