Neurologic side effects in neuroleptic-naive patients treated with haloperidol or risperidone

OBJECTIVE: To compare the side effect profile of risperidone with that of oral haloperidol in patients with no previous exposure to antipsychotic drugs (APDs). BACKGROUND: Early studies suggested that the APD risperidone may have a side effect profile comparable with that of placebo. These early studies involved patients with chronic schizophrenia and a long history of APD use. Very little information is available regarding the neurologic side effects of risperidone in patients without previous APD exposure. METHODS: The authors prospectively studied 350 consecutive neuroleptic-naive patients admitted to their acute-care psychiatry service; 34 of these were treated with risperidone (mean dose, 3.2 mg/d) and 212 were treated with low-dose haloperidol (mean dose 3.7 mg/d). All patients were assessed on admission and twice weekly thereafter using rating scales for dystonia, parkinsonism, akathisia, and dyskinesia. RESULTS: The incidence and severity of dystonic reactions, akathisia, parkinsonism, and dyskinesia were comparable in the risperidone- and haloperidol-treated groups. CONCLUSIONS: The neurologic side effect profile of low-dose risperidone is comparable with that of haloperidol in patients receiving APDs for the first time. Risperidone may not be a useful alternative to typical APDs for patients with PD and psychosis.