Risperidone improves symptoms in people who are hospitalised during an acute exacerbation of schizophrenia.

What are the relative efficacies of the atypical antipsychotics, risperidone and quetiapine, and placebo for people with schizophrenia who have been hospitalised following a recent exacerbation of their illness?METHODSDesign: Randomised controlled trial. Allocation: Unconcealed.Blinding: Double blinded.Follow up period: Two weeks.SETTING: Thirty centres in the USA, India and Romania; time frame not reported.PATIENTS: 382 adults (18-64 years) requiring hospitalisation for a recent exacerbation (within the last 4 weeks) of DSM-IV schizophrenia or schizoaffective disorder (confirmed by MINI Plus), with Clinical Global Impressions of Severity (CGI-S) >/=5, and with a score of >/= 4 on at least Iwo of the following on total Positive and Negative Syndrome Scale (PAN5S): hostility; excitement; tension; uncooperativeness; poor impulse control; total score an these five items of >/=17. Exclusion criteria: Axis I (except abuse/dependence disorders); Axis II mental retardation/bordetline personality disorder; treatment resistant schizophrenia; imminent risk of self-harm; depot antipsychotic within one dose cycle, or risperidone or quetiapine, within 7 days before baseline; allergy to risperidone or quetiapine; clinically significant or unstable disease.Intervention: Risperidone (4 or 6 mg/day by day 5), quetiapine (400 or 600 mg/day by day 5, 600 mg/day by day 8), of placebo.Outcomes: Change in total PANSS and CGI-S scare.Patient follow up: 100% (intention to treat analysis).MAIN RESULTSRisperidone significantly reduced total PANSS score compared with quetiapine or placebo over two weeks (mean change in total PANSS score: -24.1 with risperidone v -20.5 with quetiapine, p<0.01, or v -20.2 with placebo, p<0.01). Risperidone also significantly reduced CGI-S score compared with quetiapine or placebo over two weeks (mean change in CGI-S score: -1.8 with risperidone v -1.3 with quetiapine, p<0.01, or v -1.1 with placebo, p<0.01). The difference between quetiapine and placebo was not significant for either outcome measure.CONCLUSIONSRisperidone (but not quetiapine) is more effective than placebo in controlling schizophrenic symptoms (assessed by total PANSS and CGI-S scores) in hospitalised people experiencing an exacerbation of their illness.NOTESRisperidone was associated with more parkinsonism (p<0.01) and akathisia (p = 0.017) in comparison to placebo.