Effects of risperidone and olanzapine on remnant-like lipoprotein particle cholesterol (RLP-C) in schizophrenic patients

Second generation antipsychotics are associated with the risk of metabolic disorders such as diabetes mellitus and hyperlipidemia. Remnant-like lipoprotein particles cholesterol (RLP-C) are a known risk factor for cardiovascular events. The present study was performed to determine possible differences in fasting blood RLP-C levels between schizophrenic patients treated with risperidone as compared to olanzapine. Patients on olanzapine had significantly higher RLP-C levels than those on risperidone (p < 0.01). In olanzapine-treated patients there was no abnormality in fasting blood glucose levels, but fasting insulin levels and homeostasis model assessment of insulin resistance (HOMA-IR) were elevated. RLP-C levels were significantly correlated with plasma triglyceride concentrations in both the olanzapine- (p < 0.01) and risperidone-treated patients (p < 0.01). The regression line slope was greater for the olanzapine group, suggesting a greater influence of olanzapine on RLP-C. There was a significant correlation between RLP-C and HOMA-IR in the risperidone group (p < 0.01) but not in the olanzapine group (p = 0.80). These results suggest that blood glucose monitoring may not be sufficient to detect metabolic disorder and that measurement of RLP-C might be helpful for the screening for metabolic disorders associated with olanzapine therapy.     

Review of risperidone for the treatment of pediatric and adolescent bipolar disorder and schizophrenia

Risperidone is a commonly used medication for the treatment of bipolar disorder and schizophrenia in children and adolescents. It has been studied as a monotherapy treatment in early onset schizophrenia and as both monotherapy and combination therapy for pediatric bipolar disorder. Studies to date indicate that risperidone is an effective treatment for positive and negative symptoms of schizophrenia and mania symptoms of bipolar disorder. In young patient populations, side effects such as weight gain, extrapyramidal side effects, and prolactin elevation require consideration when evaluating the risk benefit ratio for individual patients. Here we review published studies of risperidone for the treatment of bipolar disorder and schizophrenia in children and adolescents to provide practitioners with an overview of published data on the efficacy and safety of risperidone in these patient populations.     

Pulmonary thromboembolism associated with olanzapine and risperidone

Several studies and reports suggest an increased risk of venous thromboembolism (VTE) in patients treated with conventional antipsychotic drugs, as well as with clozapine. We report the case of a 25-year-old man with early-onset schizo-affective disorder, with no identified risk factor for thromboembolism, who developed pulmonary embolism on three occasions, once shortly after initiating treatment with olanzapine and twice with risperidone. This case indicates that VTE can be associated with the use of olanzapine and risperidone, two atypical agents having similar properties and the same 5HT2 receptors antagonism, possibly implicated in this adverse event. As suggested by this observation, patients who have had one episode of VTE with antipsychotics with an affinity for 5HT2 receptors should receive neuroleptics from other classes, such as amisulpride, which does not interact with 5HT2 receptors. They should also be closely monitored to ensure early detection and prompt treatment of VTE.     

Population Pharmacokinetics of Risperidone and 9-Hydroxyrisperidone in Patients with Acute Episodes Associated with Bipolar I Disorder

A population model was developed with the aim to simultaneously describe risperidone and 9-hydroxyrisperidone pharmacokinetics; to obtain estimates for pharmacokinetic parameters and associated inter- and intra-individual variability of risperidone and 9-hydroxyrisperidone; and to evaluate the influence of patient demographic characteristics and other factors on risperidone, 9-hydroxyrisperidone, and active moiety pharmacokinetics. Data were obtained from 407 patients enrolled in four Phase 1 (serial blood sampling) and three Phase 3 trials (sparse sampling), representing dosage regimens ranging from 4 mg single dose to flexible 1–6 mg once daily. A pharmacokinetic model with two-compartment submodels for risperidone and 9-hydroxyrisperidone disposition and a sequential zero- and first-order absorption pathway was selected based on prior knowledge. A mixture model was incorporated due to CYP2D6 polymorphism of risperidone conversion to 9-hydroxyrisperidone. Patient characteristics tested as potential covariates were: age, sex, race, body weight, lean body mass, body mass index, creatinine clearance, liver function laboratory parameters, study, and carbamazepine comedication. The quasi-clearance of active moiety (the sum of risperidone and 9-hydroxyrisperidone) was simulated and linear regression performed to identify significant covariates. The selected pharmacokinetic model described the plasma concentration-time profiles for risperidone and 9-hydroxyrisperidone quite well and was able to determine each patient’s phenotype. Covariates significantly affecting the pharmacokinetics were carbamazepine comedication, and study because the proportion of patients assigned to the intermediate metabolizer status decreased from single to multiple dosing while the proportion assigned to extensive metabolizer status increased. Covariates with limited and clinically irrelevant effects on active moiety concentrations were patient phenotype, race, and total protein. Carbamazepine also decreased active moiety concentrations.     

Effects of Risperidone in Autistic Children and Young Adults: A Systematic Review and Meta-Analysis

There are several studies investigating the effects of risperidone on autism, but many of these studies are contradictory or inconclusive. This systematic review and meta-analysis investigated the effects of risperidone on five domains of the Aberrant Behaviour Checklist (ABC) scale on Autism Spectrum Disorder (ASD), as well as weight gain and waist circumference. The protocol for the present systematic review and meta-analysis was registered on the International Prospective Register of Systematic Reviews (PROSPERO). For this study, we analysed articles (2,459), selecting them according to the PICOS strategy (Population, Intervention, Comparison, Outcome, Study design). Although risperidone is effective for the treatment of lethargy and inadequate speech, concerns about the association between weight gain, waist circumference and risperidone require a need for evaluation of the risk-benefit ratio in its use. There was a significant association between weight gain, waist circumference and risperidone. In conclusion, it was possible to suggest the efficacy of risperidone for the treatment of lethargy and inadequate speech. Finally, we emphasize that the risk-benefit in its use should be evaluated (Protocol number CRD42019122316).     

Successful risperidone therapy for a first episode of musical auditory hallucinations in elderly patients

Although musical auditory hallucinations (MH) occur mostly in women with a history of hearing disorders, brain tumors or epilepsy, there has been insufficient symptomatological discussion to date. We present two cases in which MH occurring in old age were successfully treated with risperidone (RIS). Case 1 involved a 74‐year‐old woman who complained chiefly of insomnia and abrupt onset of MH without any other symptoms. Case 2 involved an 85‐year‐old woman with a 10‐year history of symptomatic hearing loss who had abrupt onset of MH accompanied by tinnitus. Neither patient had a history of mental illness before their initial examination and they were both treated with RIS in the outpatient clinic. The dose range of 0.2–0.5 mg daily seemed effective, with a therapeutic response appearing in 2–4 weeks. Low‐dose RIS therapy may therefore be effective pharmacotherapy for MH.     

Observations on switching patients with schizophrenia to risperidone treatment

This study examined one possible strategy for switching patients to treatment with risperidone involving immediate cessation of current neuroleptics and gradual withdrawal of anticholinergic treatments. All patients received risperidone monotherapy for at least 4 weeks. Side-effects and symptoms were rated and successful switching was defined as completion of the study with no consistent worsening in any rating scales. Of the 41 patients entered, five withdrew for reasons unconnected with the study. Of the remaining 36 patients, 64% (23 patients) were switched successfully. Overall, the rating scales showed significant improvements (mean score on Krawiecka scale, 11.0 to 6.6, P < 0.001), and side-effects decreased (mean score on Simpson & Angus scale, 5.1 to 2.9, P= 0.004). The strategy appeared to be successful for most patients, especially those who had previously received depot medication. However, more gradual withdrawal of previous treatments, including anticholinergics, may be advisable in some cases.     

利培酮替换典型抗精神病药治疗老年慢性精神分裂症阴性症状的疗效及安全性

目的评价利培酮替换典型抗精神病药治疗老年慢性精神分裂症患者阴性症状的疗效和安全性。方法53例老年慢性精神分裂症患者分为2组,观察组32例患者给予利培酮替换典型抗精神病药治疗,对照组21例患者继续接受典型抗精神病药治疗,治疗6个月。2组患者入组时(治疗前)和治疗1、3、6个月末分别进行阳性与阴性症状量表(PANSS)评定,应用治疗时出现的症状量表(TESS)评定不良反应。结果 2组患者治疗前PANSS总分、阴性因子和阳性因子评分比较差异均无统计学意义(P>0.05)。2组患者治疗1、3、6个月末PANSS总分、阴性因子和阳性因子评分均显著低于治疗前,差异有统计学意义(P<0.05)。治疗1、3、6个月末,观察组患者PANSS总分、阴性因子和阳性因子评分均显著低于对照组,差异有统计学意义(P<0.05)。2组患者治疗前TESS评分比较差异无统计学意义(P>0.05)。对照组患者治疗前与治疗1、3、6个月末TESS评分比较差异均无统计学意义(P>0.05)。观察组患者治疗1、3、6个月末TESS评分显著低于治疗前,差异均有统计学意义(P<0.05)。2组患者治疗1个月末时TESS评分比较差异无统计学意义(P>0.05);治疗3、6个月末,观察组患者TESS评分显著低于对照组,差异均有统计学意义(P<0.05)。结论利培酮替换典型抗精神病药治疗老年慢性精神分裂症阴性症状起效快,疗效好,不良反应少,安全性高,耐受性好。     

氯氮平与利培酮对血清脂联素的影响

目的：研究氯氮平与利培酮对血清脂联素（Adi）等代谢的影响。方法：69例精神分裂症患者随机分为氯氮平组和利培酮组。治疗6周测定患者血清Adi,血脂,空腹血糖、胰岛素水平,计算胰岛素抵抗指数（IR）,测量身高、体质量,计算体质量指数（BMI）,并与36名正常对照者比较。结果：两患者组治疗后的血清Adi明显降低,氯氮平组血清Adi改变与BMI相关;利培酮组血清Adi改变与IR和利培酮剂量相关。结论：氯氮平与利培酮治疗精神分裂症患者可引起血清Adi降低,并与体质量增加、IR、血脂及利培酮剂量密切相关。