Psychosis risperidone

Jha A, Fourie H Risperidone treatmenr of amphetamine psychosis fietter). Br J Psychiatry 174 366, 1999... 

McDougle CJ, Price LH, Palumbo JM, et al Dopaminergic responsivity during cocaine abstinence a pilot smdy. Psychiatry Res 43 77-85, 1992 McDougle CJ, Black JE, Malison RT, et al Noradrenergic dysregulation during discontinuation of cocaine use in addicts. Arch Gen Psychiatry 51 713-719,1994 Misra L, Kofoed L Risperidone treatment of methamphetamine psychosis (letter). Am J Psychiatry 154 1170, 1997... 

Verma, S. K. et al. (2005). Plasma risperidone levels and clinical response in patients with first-episode psychosis. /. Clin. Psychopharmacol, 25(6), 609-11. 

Brodaty H, Ames D, Snowdon 1 et al. (2003) A randomized placebo-controlled trial of risperidone for the treatment of aggression, agitation, and psychosis of dementia. 1 Clin Psychiatry 64(2) 134-143... 

Solon EN. (1996). Risperidone-reserpine combination in refractory psychosis. Schizophr Res. 22(3) 265-66. 

Atypical antipsychotics may be helpful in managing the delusions and agitated behavior that can accompany dementia. These medications, include risperidone (Risperdal), quetiapine (Seroquel), ziprasidone (Geodon), aripiprazole (Abilify), and olanzapine (Zyprexa). All antipsychotics, typical and atypical, appear to increase the risk of death in patients with dementia and psychosis. This appears as a warning in the package inserts of the newer drugs. A prudent approach is to discuss this risk with the caregiver, use the lowest effective dose, and monitor for effectiveness. 

Cerebrovascuiar effects Gerebrovascular adverse reactions (eg, stroke, transient ischemic attack), including fatalities, were reported in patients (mean, 85 years of age range, 73 to 97 years of age) in trials of risperidone in elderly patients with dementia-related psychosis. 

Psychosis Intravenous haloperidol Risperidone/atypicals Low potency neuroleptics... 

Kramer, T.M., and Cottingham, E.M. (1999) Letter to the editor risperidone in the treatment of steroid-induced psychosis. / Child Adolesc Psychopharmacol 9 315-316. 

Katz IR, Jeste DV, Mintzer JE, et al Comparison of risperidone and placebo for psychosis and behavioral disturbances associated with dementia a randomized, double-blind trial Risperidone Study Group. J Clin Psychiatry 60 107-115, 1999... 

Atypical antipsychotics cause fewer EPS than do conventional antipsychotics. Clozapine and quetiapine are the least likely to cause EPS and are therefore recommended for treatment of psychosis in patients with Parkinson s disease. With the notable exception of risperidone, atypical antipsychotics cause substantially less hyperprolactinemia than do conventional antipsychotics. Weight gain is a side effect of all atypical antipsychotics except ziprasidone and aripiprazole. Concerns about cardiac conduction delay with ziprasidone therapy exist and warrant consideration in patients who have... 

Mood Disorders. Risperidone has also been reported to benefit major depressive disorder with psychosis, bipolar mania, and schizoaffective disorder ( 83, 84, 85, 86 and 87). 

Case Example Because of a patient s partial response to 5 months of clozapine therapy at 600 mg/day, risperidone was added for augmentation (started with 0.5 mg b.i.d. and increased to 1 mg b.i.d. after 1 week). Before this addition, the clozapine plasma level was 344 ng/mL, but after 2 weeks of risperidone augmentation, the level was elevated to 598 ng/mL with no adverse effects and substantial clinical benefit. In another report, there was an increase in the steady-state plasma levels of clozapine (675 mg/day) and its active metabolite norclozapine after the addition of risperidone 2 mg/day in a patient treated for 2 years. Before the addition of risperidone, her clozapine and norclozapine levels were 829 and 1,384 ng/mL, respectively. Two days after risperidone was added, these levels rose to 980 and 1,800 ng/mL. Clozapine dosage was reduced to 500 mg/day, and after 5 days of combined treatment with 4 mg/day of risperidone, the clozapine and norclozapine levels were 110 and 760 ng/mL, respectively. Aside from some mild oculogyric crises, she had no symptoms of clozapine toxicity or clinical changes during the period of cross-tapering. In another case, risperidone was added to clozapine because the patient had relapsed after discontinuation of fluphenazine and had not responded to clozapine. The addition of risperidone resulted in an acute remission of psychosis ( 100). 

Antiserotonergic drugs (e.g., risperidone and cyproheptadine) were of some value in treating the withdrawal psychosis and other somatic withdrawal symptoms. 

Chouinard G, Vainer JL, Belanger M-G, et al. Risperidone and clozapine in the treatment of drug-resistant schizophrenia and neuroleptic-induced supersensitivity psychosis. Prog Neuro-Psychopharmacol Biol Psychiatry 1994 18 1129-1141. 

Daniel DG, Weinberger DR, Kleinman JE, et al. Risperidone versus clozapine in psychosis. Presented at the 147th Annual Meeting of the American Psychiatric Association, Philadelphia, May 1994. 

Risperidone Acute Clinical Trials. Hillert et al. (107) found risperidone to have both antipsychotic and antidepressive properties in 10 patients with schizoaffective disorder, depressed type. These investigators prescribed 2 to 10 mg/day for 6 weeks in an open-label pilot study, and found marked improvement in psychosis in all patients and clinically significant overall improvement in psychosis in 7 to 10 patients. Two patients required antiparkinsonian drugs otherwise risperidone was well tolerated by the group. 

Singh AN, Catalan J. Risperidone in HIV-related manic psychosis. Lancet 1994 344 1029-1030. 

In an open study of 11 patients with typical borderline personality, Schulz et al. ( 253) found substantial improvement with olanzapine, particularly in psychosis, but also in anergia, hostility, and interpersonal sensitivity. Szigethy and Schulz ( 254) reported improvement in one patient whose BPRS went from 46 to 28 with risperidone. Remission of self-mutilation has also been reported in one borderline patient undergoing treatment with risperidone, as well as an SSRI, for depression (255). This patient was then able to return to a full-time job. Although one should reserve judgment until more definitive studies are completed, the more favorable side effect profile of risperidone and olanzapine suggests that these drugs may be useful when psychotic or near psychotic symptoms are present. 

Fig. 11—40) and clinical features, not only as compared with clozapine (Fig. 11 — 37) but also as compared with risperidone (Fig. 11—39)- Olanzapine is atypical in that it generally lacks EPS, not only at moderate doses but usually even at high doses. Thus, olanzapine tends to be used for some of the most difficult cases of schizophrenia, bipolar disorder, and other types of psychosis in which good control of psychosis without EPS is still desired, yet aggressive treatment is required. On the other hand, this approach can be very expensive. 

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. 

A case report has suggested that risperidone, an atypical neuroleptic drug, can be useful in treating adolescents with glucocorticoid-induced psychosis and may hasten its resolution (105). 

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