Risperidone Induced Dystonic Reaction and Akathisia

(1995) Peer review of risperidone in the treatment of patients with chronic schizophrenia a multinational , multi-centre, double-blind, parallel-group study versus haloperidol.(1998) Alteration in the recommended dosing strategy for risperidone. REPLY Sir, Kindly refer to the comments of Duggal and Nizamie on our paper. We are grateful to them for the interest shown in our paper. Our responses to their comments are given below-I. The commetators have suggested that the PANSS should have been administered before and after the wash-out period. This has been clearly stated in the methodology section that THE EDITOR PANSS was done before and after wash-out and people showing 20% improvement were dropped. 2. The concept of primary and secondary negative symptoms is still evolving and at the time the study was undertaken in 1996 this issue has not yet crystalised. That is why no attempt was made to differentiate primary from secondary negative symptoms. 3. This study was done on patient consulting the clinic, on specified days and fulfilling the inclusion and exclusion criteria. Stability of symptomatology was not a criteria. However, chronic schizophrenic patients who had acute exacerbation were excluded. It has been also clearly stated in methodology thus the patients were more or less stable. 4. There were 71 patients on 8 mg & 28 (37%) of them developed EPS whereas, 75 patients were on 6 mg & 37 (49%) developed EPS. Thus the dose of 6 and 8 mg did not show much difference on development of EPS in these patients. US/Canada study, also showed that patients on risperidone need same amount of anticholenergics as patients on haloperidol. 5. Dose escalation was done as per recommended protocol at that time. It is possible that increase in autonomic instability was due to this reason. 6. Clinical drug trial do recommend flexible dose design. In this study fixed dose design was used to study the acceptability of two recommended dosage. Earlier studies on risperidone have also used fixed dose design. The conclusions of any study have to be interpreted keeping in mind the strength and weaknesses of the study. A good study should allow readers to make independent conclusions.