Guideline for the pharmacotherapy of treatment-resistant schizophrenia. Royal College of Psychiatrists of Thailand.

The authors proposed to develop an evidence-based guideline relevant to drug use for treatment-resistant schizophrenia (TRS), which will be called "Guideline for the Pharmacotherapy of Treatment-Resistant Schizophrenia or PTRS Guideline". The authors performed a MEDLINE search (between 1966 and December 1998) and classified the study designs of those trials by using the system proposed by the Agency for Health Care Policy and Research (AHCPR). The levels of evidence were graded and recommendations were made by the use of a system modified from that of the AHCPR. One hundred and sixty-three articles met the inclusion criteria for the review. For a schizophrenic patient who does not respond to a classical antipsychotic, physicians should switch from the first classical antipsychotic to the second one, which belongs to a different class. A schizophrenic patient who does not respond to at least two adequate trials of classical antipsychotics should be classified as a TRS patient. Clozapine should be considered as a first-line treatment for TRS. Risperidone should be considered in a TRS patient who refuses to have regular blood monitoring or has contraindication for clozapine. Physicians should use this guideline to accompany others that suggest the overview of treatment for schizophrenia. Appropriate application and the limitations of the guideline are also discussed.

Efficacy and tolerability of risperidone in chronic schizophrenic Thai patients.

Risperidone is a novel serotonin-dopamine antagonist antipsychotic in a class of benzisoxazole derivative which has been shown to be effective in reducing psychotic symptoms in schizophrenia. The study was designed as perspective, 8-week, multicenter, open label study in schizophrenic patients from 6 psychiatric hospitals. One hundred and twenty cases were recruited and 105 patients completed the study. The average total PANSS score at the baseline was 90.6 (range 60-133). Patients were evaluated with quantitative rating scales for the efficacy (PANSS score) and extrapyramidal rating scale at week 4 and 8 after starting risperidone treatment. The titrated dose of risperidone was given to the patients with the final dose of 6 mg risperidone throughout the study period. At week 4, the average PANSS score was significantly reduced to 73.4 (p < 0.05). The average PANSS score at week 8 was further declined to 61.9 which was significantly different (P < 0.05) from the baseline. Seventy-eight cases (74.3%) were classified as responders (those patients showing more than 20 per cent decrease in PANSS score). Extrapyramidal side effect was occurred in some patients, but usually mild and tolerable. However twenty-four patients (22.9%) required medications for this side effect. Other adverse reactions were insomnia found 15 cases (14.3%), elevated hepatic enzyme 5 cases (4.8%) and weight gained 2 cases (1.9%). Our data suggested that risperidone is effective and well-tolerated in chronic schizophrenic Thai patients.