Antipsychotics risperidone

Antiadrenergic drugs (prazosin) can be useful in some patients with PTSD, and antipsychotics (risperidone, quetiapine, and olanzapine) may be used as augmenting agents in partial responders. 

When a satisfactory therapeutic response cannot be achieved with any single agent in conjunction with concomitant psychotherapy, augmentation strategies warrant consideration. Preferred augmentation strategies include (1) an atypical antipsychotic (risperidone, olanzapine), (2) clomipramine, (3) buspirone, and (4) pindolol. 

Clozapine was the first atypical antipsychotic released in the United States. However, clozapine is associated with the risk of leukopenia and, potentially, lethal agranulocytosis. Because of these concerns, hematological monitoring during clozapine pharmacotherapy is required (Alphs and Anand, 1999). Due to these hematological risks, clozapine is indicated only for patients with treatment-resistant schizophrenia. The other atypical antipsychotics, risperidone, olanzapine, quetiapine, and ziprasidone, that are marketed in the United States can be used as first-line treatments for adults with schizophrenia. 

In the Expert Consensus survey (Rush and Frances, 2000), respondents were asked to rate which classes of medication may be helpful for treating patients with severe and persistent physical aggression and those who destroyed property. The atypical antipsychotics were rated most highly, followed by anticonvulsant/ mood stabilizer. These were followed (with much lower priority) by antidepressants and beta-blockers. Among the atypical antipsychotics, risperidone was rated most highly, followed by olanzapine others had much lower ratings. Divalproex or valproic acid and carbamazepine were rated highest of the mood stabi-... 

Compared with the history of clozapine, the development of the more recent atypical antipsychotics risperidone and olanzapine appears almost... 

In a report of 122 elderly patients on risperidone, hypotension was noted in 28.7% and symptomatic orthostatic hypotension was noted in 9.8%. Significant decreases in blood pressure occurred with risperidone treatment (p = 0.0001) and were common in patients with cardiovascular disease and those taking an SSRI or valproate (p = 0.03) (502). Hence, like other antipsychotics, risperidone should be prescribed cautiously for elderly patients and those with preexisting cardiac disease. Its hypotensive versus its orthostatic hypotensive effects may be an age-related pharmacodynamic response. Blood pressure, including orthostatic blood pressure, should be monitored routinely until the risperidone dosage is stabilized. Furthermore, when risperidone therapy is initiated in the elderly, dosage should be titrated from 0.25 to 0.5 mg two times a day with increments of 0.25 to 0.5 mg weekly (92). 

Leysen JE, Janssen PM, Gommeren W, et al. In vitro and in vivo receptor binding and effects on monoamine turnover in rat brain regions of the novel antipsychotics risperidone and ocaperidone. Moi Pharmacoi 1992 41 494-508. 

The magnitude of these properties is far from trivial and, in feet, makes the four atypical antipsychotics risperidone, olanzapine, quetiapine, and ziprasidone easily preferable as first-line therapies for psychosis, with conventional antipsychotics and clozapine as second-line therapies. 

Bhanji NH, Chouinard G, Margolese HC. A review of compliance, depot intramuscular antipsychotics and the new long-acting injectable atypical antipsychotic risperidone in schizophrenia. Eur Neuropsychopharma-col. 2004 14 87-92. 

Other classes of medications that may be used for pediatric insomnia include mood stabilizers/anticonvulsants (depakote), other classes of antidepressants (mir-tazapine), atypical antipsychotics (risperidone), and chloral hydrate, as well as herbal... 

Fig. 13.1 Chemical structure of clozapine, some of its structural analogues, typical (chlorpromazine, haloperidol) and atypical antipsychotics (risperidone, ziprasidone, sertindole and amisulpride) unrelated to clozapine.

These results were subsequently replicated in a double-blind, placebo-controlled crossover study (Heresco-Levy et al., 2005) in which D-serine or a placebo was added to atypical antipsychotics (risperidone... 

Davis JM, Chen N. Clinical profile of an atypical antipsychotic risperidone. Schizophr Bull 2002 28(1) 43-61. 

Madhusoodanan S, Suresh P, Brenner R, Pillai R. Experience with the atypical antipsychotics—risperidone and olanzapine in the elderly. Ann Clin Psychiatry 1999 ll(3) 113-8. 

Responders to drug therapy should continue treatment for at least 12 months. When discontinued, drug therapy should be tapered slowly over a period of 1 month or more to reduce the likelihood of relapse. Antiadrenergic drugs (prazosin) can be useful in some patients with PTSD, and antipsychotics (risperidone, quetiapine, and olanzapine) may be used as augmenting agents in partial responders. 

Try one of the other first-line atypical antipsychotics (risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole)... 

Clozapine and olanzapine are the most likely of the atypical agents to cause anticholinergic (anti-muscarinic) effects. They are more likely than other atypicals to cause weight gain (glucose tolerance may be impaired and should be monitored in susceptible individuals) and are second only to quetiapine in their sedative effects. Sexual dysfunction and skin problems are rare with atypical antipsychotics. Risperidone and amisulpride are as likely as classical antipsychotics to raise prolactin concentrations and cause galactorrhoea. 

C Risperidone. Although the incidence of adverse effects associated with hyperprolactinemia is rare with atypical antipsychotics, risperidone can inaease prolactin levels in a dose-dependent manner. Blockade of the dopaminergic tone in the hypothalamus and 5HT-2 antagonism by risperidone may explain this effect. Other adverse eff associated with persistent prolactin elevation include sexual dysfunction, female menstrual disorders, and reduced bone mineral density. 

Wilton LV, Heeley EL, Pickering RM, Shakir SA. Comparative study of mortality rates and cardiac dysrhythmias in post-marketing surveillance smdies of sertindole and other atypical antipsychotics, risperidone and olanzapine. J Psychophamtacol 2001 15 120-6. 

Conventional antipsychotics improve symptoms of hyperactivity and impulsivity, but may have negative effects on learning and cognitive functioning as well as extrapyramidal side effects (e.g., dystonia and tardive dyskinesia) that limit their usefulness. The atypical antipsychotics risperidone, olanzapine, quetiapine, and ziprasidone have been used to control severe aggression in refractory cases of ADHD, particularly if conduct disorder or bipolar disorder coexists. More studies are needed to clarify their place in therapy. ... 

Phenothiazines, butyrophenones, diphenylbutylpiperidines and thioxanthenes can oppose the effects of levodopa because of their dopamine antagonist properties, causing deterioration of motor function in Parkinson s disease. The antipsychotic effects and ex-trapyramidal adverse effects of these drugs can be opposed by levodopa. Of the atypical antipsychotics, risperidone and olanzapine cause deterioration in motor function in Parkinson s disease. Ziprasidone may act similarly, and there have been reports with quetiapine. Clozapine does not have this effect. 

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