Re-emergence of Positive Symptoms of Schizophrenia during the Course of Treatment with Risperidone

Sir, We would like to respond to the article titled "Re-emergence of positive symptoms of schizophrenia during the course of treatment with risperidone" (Bajaj et al.), that was published in the Indian Journal of Psychiatry, Vol.41/No.2/April, 1999. It was quite interesting to note that these authors had observed a re-emergence of positive symptoms in 7 patients, out of 30 patients of schizophrenia treated with risperidone. We would like to present a brief report of a similar phenomenon observed in one schizophrenic patient undergoing treatment in the Dept. of Psychiatry, JIPMER Hospital, Pondicherry. Mr.X, a 28-yr. old unmarried male was hospitalized in August,1999 with an ICD-10 diagnosis of residual schizophrenia. His illness had, by then, run a chronic unremitting course for three years, with a definite progression from an initial brief phase characterised by overt positive symptoms to the second and chronic stage, comprising all the typical negative symptoms such as avolition, apathy, social withdrawal, anhedonia, blunted affect and a gross reduction in speech output. A detailed cross-sectional evaluation soon after admission did not reveal any disorder of form of thought, delusions, thought-alienation phenomena or perceptual disturbances. Patient's baseline BPRS score was 24. Baseline PANSS profile was as follows : Positive syndrome score=11, negative syndrome score=46, general psychopathology score=39. Risperidone was initiated at a dose of 2 mg/day and gradually incraesed to a total of 8 mg/day in 2 divided doses. After 2 weeks of treatment with 8 mg of risperidone, interesting changes were observed in the patient's clinical profile and his scores on BPRS and PANSS. Total BPRS score had increased to 26, while the PANSS scores were as follows : Positive syndrome score=27, negative syndrome score=27, general psychopathology score=39. These rating scale scores correlated with clinically observed worsening of positive symptoms, especially conceptual disorganization and grandiosity and improvement in negative symptoms.