Abstract
It has been proposed that atypical antipsychotic drugs like clozapine are highly beneficial for the treatment of patients with disorganised or hebe-phrenic schizophrenia resulting in prominent clinical and social improvements [1]. Risperidone is a new-generation, atypical antipsychotic agent with potent dopaminergic and serotonergic antagonistic activity. Risperidone has been found to be efficacious in the treatment of schizophrenia, bipolar disorders and pervasive development disorders [2–4]. However, no reports or studies are available about the usefulness of risperidone in treatment of patients suffering from disorganised (DSM-IV criteria) or hebephrenic (ICD-10 criteria) schizophrenia.
We describe a 20-year-old, white, male patient who was diagnosed with a 2-year history of hebephrenic schizophrenia meeting ICD-10 criteria. The patient was first hospitalised in spring 1999 and there was no previous exposure to classic or atypical antipsychotics before admission. The patient was alert and orientated. Affective changes were prominent: inappropirate mood with self-absorbed smiling, grimaces, mannerisms and reiterated phrases. Hypochondriacal complaints occurred. Thinking was disorganised and his speech was rambling and incoherent. He suffered from fleeting and fragmentary delusions and hallucinations. His behaviour was empty of purpose, aimless and there was a strong social deprivation in combination with criminalistic acts. Physical and neurological examination, electroencephalography, routine laboratory screening and magnetic resonance imaging revealed no abnormalities. There was no history of substance abuse.
A regimen of risperidone treatment was undertaken in the patient. Risperidone-intake was started with an initial dose of 2 mg per day which was increased over 2 days to 6 mg per day. With the risperidone dose titrated gradually, an optimal clinical response was found at a daily risperidone dose of 9 mg after 7 weeks of treatment. Clinical response was assessed using the Brief Psychiatric Rating Scale (BPRS) and the Clinical Global Impression (CGI) scale. After 10 weeks of treatment the patient's total BPRS score dropped from 68 to 36; the CGI score improved from 6 to 2. These scores remained stable. No risperidone-induced side-effects (including extrapyramidal side-effects) were experienced. Twelve weeks after admission the patient was discharged.
In conclusion, risperidone appeared to be safe and effective in ameliorating symptoms of hebephrenic schizophrenia. Data on other atypical neuroleptics in this disorder are still sparse, and controlled studies are wanted to clarify the role of risperidone in the treatment of hebephrenic schizophrenia.