Anxiety risperidone

Patients seen for flashbacks are treated with oral diazepam (15—30 mg/day for adults) if symptoms of anxiety are severe (Rumack 1987). Neuroleptics, especially haloperidol, have been implicated in a transient increase in visual flashbacks and are not recommended (Moskowitz 1971 Strassman 1984). Risperidone and selective serotonin reuptake inhibitors may also worsen symptoms of hallucinogen persisting perception disorder (Halpern and Pope 2003). The patient needs assurance of the self-limiting nature of the phenomenon and its decreasing frequency of reoccurrence with time. The patient should be reminded that any future use of hallucinogens or marijuana may precipitate similar symptoms (Strassman 1984). 

Among these choices, bnspirone is preferred if the patient is also experiencing anxiety. If the patient is depressed and agitated, a SSRI should be tried first. Second line choices inclnde carbamazepine (Tegretol) or one of the atypical antipsychot-ics—ziprasidone (Geodon), risperidone (Risperdal), olanzapine (Zyprexa), quetiap-ine (Seroquel), or aripiprazole (Abilify) can be tried. If psychotic symptoms are present, one of the atypical antipsychotics should be tried first. 

Several reports also suggest that adjunctive risperidone (Giakas, 1995 Jacobsen, 1995 Lombroso et al., 1995 McDougle et al., 1995 Ravizza et al., 1996 Stein et al., 1997)or olanzapine (Peris and Szerman, 2000) may be helpful in treatment-resistant OCD. Systematic data in pediatric samples are needed, however, before such an approach can be recommended, and there are anecdotal reports of increased obsessions and anxiety with the atypical neuroleptics (Alzaid and Jones, 1997 Andrade, 1998 Mottard and de la Sa-blonniere, 1999). 

Risperidone > placebo for repetitive phenomena, aggression, anxiety, depression, irritability, and autistic symptoms... 

Conley et al. (121) reported a large, double-blind study comparing risperidone with olanzapine. This study included about 400 patients randomly assigned to a flexible dose of risperidone (2 to 6 mg) or olanzapine (5 to 20 mg) for 8 weeks. On many measures, clinical improvement was the same however, risperidone did produce a slightly greater improvement than olanzapine on positive symptoms and on the anxiety/depression subscale. Most patients on risperidone received 4 to 6 mg/day, whereas half the patients on olanzapine received 10 mg and 10% received 5 mg. The mean dose of risperidone was 4.8 mg/day and for olanzapine 14.3 mg/day. 

Risperdal has a particular tendency to produce adverse stimulant effects, including insomnia, agitation, and anxiety. Probably because of these stimulant effects, it may have an increased risk of causing mania (Dwight et al., 1994). Stimulation may also account for risperidone-induced... 

A single case report (Byerly et al., 1995) indicated that risperidone can produce severe akathisia, described as behavioral stimulation with anxiety and agitation. In a study of clozapine, 2 of 29 patients developed akathisia, one mild and the other moderate in intensity (Chengappa et al., 1994). 

A 40-year-old man had taken clozapine 450 mg/day and risperidone 6 mg/day for several years. Nefazodone 200 mg/day was added in an attempt to improve persistent negative symptoms, and after a week the dosage was increased to 300 mg/day. One week later, he reported anxiety and dizziness and was hypotensive. The combined concentrations of clozapine and its active metabolite norclozapine had increased from 309 ng/ml before nefazodone to 566 ng/ml. The nefazodone dosage was reduced to 200 mg/day and the anxiety, dizziness, and hypotension resolved over the next 7 days. At the same time plasma concentrations of clozapine and norclozapine fell to 370 ng/ml. 

Patients with bipolar disorders may benefit from risperidone. This has been observed in an open trial of ten patients with rapid cycling bipolar disorder who were refractory to lithium carbonate, carbamazepine, and valproate eight improved after 6 months of treatment. One patient dropped out through non-adherence to therapy and one because of adverse effects (agitation, anxiety, insomnia, and headache) (5). There was a similar beneficial effect in eight adults with moderate to profound mental retardation (6). Risperidone was associated with a significant reduction in aggression and self-injurious behavior, whereas adverse effects were primarily those of sedation and restlessness. 

The medical records of 151 hospitalized elderly psychiatric patients (mean age 71 years) have been analysed (8). Of 114 patients treated with risperidone (mean duration of treatment 17 days mean dose 3 mg/day), 78% responded. Adverse events were reported in 20 patients, including new-onset extrapyramidal effects in four tremor in four sedation in three hypotension in three diarrhea in two tardive dyskinesia in two and chest pain, anxiety, restlessness, itching, insomnia, and falls in one each. 

Visual distortion with generalized anxiety and panic attacks has been attributed to risperidone (SEDA-22, 69). Visual disturbance resembling hallucinogen persistent perception disorder occurred after each of three consecutive risperidone dosage increases in a 55-year-old woman there was absence of substance abuse (129). 

Finally, of 192 patients who had remained symptomatically stable for at least 1 month with another major second-generation antipsychotic drug, olanzapine (mean age 38 years 63% men), 70% completed a 6-month study with injectable risperidone treatment-related adverse events were reported by 121 patients (63%), mostly anxiety (12%), exacerbation of disease (10%), insomnia (9%), depression (6%), and akathisia (5%) (231). 

Hori M, Shiraishi H. Risperidone-induced anxiety might also develop awakening phenomenon. Psychiatry Clin Neurosci 1999 53(6) 682. 

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