A pilot,open study on the treatment of refractory schizophrenia with risperidone and clozapine

The aim of this report is to show the results of a pilot, open label treatment programme for resistant schizophrenics in which risperidone was used before clozapine. Thirteen DSM III R, drug resistant schizophrenics were treated with risperidone p.o. at doses up to 16 mg/day for three months. Clinical assessment was performed before and after 1, 2 and 3 months of treatment by means of the Brief Psychiatric Rating Scale (BPRS) and of the Scales for the Assessment of Positive and Negative Symptoms of Schizophrenia. Non-responders to risperidone were then treated with clozapine (up to 600 mg/day) for the next month. Seven patients responded to risperidone (improvement over 20 per cent in each rating scale, BPRS total score below 35), While five risperidone non-responders or partial responders improved dramatically after following clozapine tretment. Results suggest that heterogeneity in response to atypical antipsychotics may overshadow a heterogeneity in underlying biological factors.