Clinical utility of the risperidone formulations in the management of schizophrenia

Risperidone is one of the early second-generation antipsychotics that came into the limelight in the early 1990s. Both the oral and long-acting injectable formulations have been subject to numerous studies to assess their safety, efficacy, and tolerability. Risperidone is currently one of the most widely prescribed antipsychotic medications, used for both acute and long-term maintenance in schizophrenia. Risperidone has better efficacy in the treatment of psychotic symptoms than placebo and possibly many first-generation antipsychotics. Risperidone fares better than placebo and first-generation antipsychotics in the treatment of negative symptoms. Risperidone’s long acting injectable preparation has been well tolerated and is often useful in patients with medication nonadherence. Risperidone has a higher risk of hyperprolactinemia comparable to first-generation antipsychotics (FGAs) but fares better than many second-generation antipsychotics with regards to metabolic side effects. In this article, we briefly review the recent literature exploring the role of risperidone formulations in schizophrenia, discuss clinical usage, and highlight the controversies and challenges associated with its use

Axis I and personality comorbidity in adolescents with conduct disorder. The Bulletin of the American Academy of Psychiatry and

This study was undertaken to investigate psychiatric comorbidity in male and female adolescents with conduct disorder diagnoses. Twenty-five hospitalized adolescents (1 1 females, 14 males) with conduct disorder were evaluated using structured diagnostic interviews for Axis I and personality disorders. The most common Axis I comorbid diagnoses were: depressive disorders (major depression andlor dysthymia), 64 percent; anxiety disorders (separation anxiety disorder, overanxious disorder, panic disorder, obsessive-compulsive disorder, phobias, and/or posttraumatic stress disorder), 52 percent; substance abuse, 48 percent; and attention-deficit hyperactivity disorder, 28 percent. Common Axis II disorders included passive-aggressive personality disorder, 56 percent, and borderline personality disorder, 32 percent. When compared with the male subjects, the females had significantly more total Axis I disorders and a trend toward more total personality disorders, anxiety disorders, depression, and borderline personality disorders. These findings support conduct disorder as a complex illness with extensive Axis I and II involvement as well as some gender differences in presentation

DSM-Ill Diagnoses and Offenses in Committed Female Juvenile Delinquents

The relationship between juvenile delinquency and psychiatric disorders remains poorly understood. However, it is becoming more apparent that the spectrum of psychiatric illness present in juvenile delinquents is broader than once believed. Fifteen female juvenile delinquents committed to a residential treatment program were assessed for DSM-Ill diagnoses, using a structured diagnostic interview, the Diagnostic Interview for Children and Adolescents (DICA). A search of the literature revealed no other reports using the DICA in female juvenile delinquents. A broad spectrum of current and past diagnoses was discovered, including conduct disorder (10O0/0), substance abuse/dependence (87%), major depression (67%), and anxiety disorders (47%). The average number of lifetime diagnoses per subject was 4.7; current diagnoses averaged 3.4 per subject. Additionally, criminal and status offense records were obtained for each subject. No significant relationship was noted between diagnoses and categories of offense. These results add further evidence for the presence of frequent and severe psychiatric disturbances in this population, and the need for increased clinical and research efforts by the psychiatric community. The boundaries between psychiatric illness and the terms conduct disorder and delinquency remain poorly understood. Lewis er ul.' noted that the diagnosis of conduct disorder encompasses a multiplicity of signs and symptoms characteristic of other psychiatric disorders, and that often the difference between psychiatrically hospitalized adolescents and found that the psychopathology in a sample of delinquent and nondelinquent psychiatrically hospitalized adolescent boys was similarly severe. and that at one time the majority of the delinquents had been regarded as severely psychiatrically disturbed. These two reports point out the presence of multiple and serious psychiatric symptoms in youth with antisocial behavior. yet the investigators' reliance on past records to generate their data bases and the lack of a standard diagnostic classification system precluded the identification of valid and reliable psychiatri