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PSH0010.1177/2010105815618673Proceedings of Singapore HealthcareChee et al.

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Original Article OF SINGAPORE HEALTHCARE

Proceedings of Singapore Healthcare

Short term effectiveness of haloperidol 2016, Vol. 25(2) 72­–79

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DOI: 10.1177/2010105815618673

schizophrenia psh.sagepub.com

Ashwin Weng Seng Chee, Edimansyah bin Abidin and Swapna Kamal Verma

Abstract
Aim: The supposed superiority of second-generation antipsychotic medication over first-generation antipsychotic medication
has been challenged recently by several studies. This naturalistic retrospective study aims to compare outcomes between
patients admitted for the first time with first-episode schizophrenia-spectrum disorders who were started on either haloperidol
or risperidone. Would choice of antipsychotic affect length of admission and three-month outcome?
Methods: Seventy-seven patients from the Early Psychosis Intervention Programme at the Institute of Mental Health were
included in this study. Length of stay was obtained from hospital electronic records. Positive and Negative Syndrome Scale
(PANSS) and Global Assessment of Functioning (GAF) scores at three months were used to assess severity of psychopathology
and level of functioning respectively. A secondary analysis was also done to measure time to discontinuation for any reason.
Results: There was a significant reduction in PANSS total, positive, negative and general psychopathology scores in both
groups at three months, with the patients on risperidone showing a greater reduction in PANSS negative scores compared to
the patients on haloperidol. However, there were no statistically significant differences between length of hospitalization and
total PANSS score at three months between the two groups. Time to discontinuation was longer in the risperidone group
compared to the haloperidol group.
Conclusion: The findings of this study suggest that risperidone has a better effect on negative symptoms and is better
tolerated, resulting in a longer time to discontinuation. Thus, starting a patient with first-episode schizophrenia-spectrum
disorder on risperidone would result in a better short-term outcome as compared to starting the same patient on haloperidol.

Keywords
Haloperidol, risperidone, first-episode schizophrenia, effectiveness

Introduction
Schizophrenia is a serious and potentially chronic mental dis-
order with a profound impact on patients, their families, and
society. Worldwide, psychotic illnesses rank third among the
most disabling conditions and impose an enormous burden in
economic cost and human suffering.1 Thus, it has become of
much interest to establish what is the most effective way to
treat this condition. Antipsychotic medication remains the
mainstay of treatment for schizophrenia. When second-
generation antipsychotics were introduced, they were mar-
keted as offering greater efficacy in reducing psychotic
symptoms while reducing side effects.2 However, this sup-
posed superiority over first-generation antipsychotics has
been challenged in recent times.3
The efficacy of second-generation antipsychotics in treat-
ing both the positive and negative symptoms of psychosis has
been proven in many studies.4,5 However, most of these stud-
ies were in the form of randomized controlled trials that
were performed in controlled situations which did not reflect
the conditions faced by clinicians in actual day to day
practice.
Two studies in particular have challenged the assumption
that second-generation antipsychotics are superior to first-
generation antipsychotics in schizophrenia by comparing
their effectiveness in real world situations. The Clinical
Antipsychotic Trials of Intervention Effectiveness (CATIE),6
involved 1493 patients with schizophrenia recruited from 57
sites in USA and randomly assigned to receive olanzapine,
perphenazine, quetiapine or risperidone for up to 18
months. The CATIE study showed that the efficacy of the
Institute of Mental Health, Singapore
Corresponding author:
Ashwin WS Chee, Institute of Mental Health, 10 Buagkok View, 539747,
Singapore.
Email: ashwin_ws_chee@imh.com.sg

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Chee et al. 73
only first-generation antipsychotic medication in the trial,
perphenazine, appeared to be similar to that of other sec-
ond-generation antipsychotic medications, but adherence to
therapy was highly affected by tolerability, with approxi-
mately 74% of patients discontinuing their medications
before 18 months of treatment. Olanzapine was the most
effective in terms of rates of discontinuation but was associ-
ated with greater weight gain and increases in measures of
glucose and lipid metabolism.
The Cost Utility of the Latest Antipsychotic Drugs in
Schizophrenia Study (CUtLASS 1)7 was a pragmatic, multisite,
randomized controlled trial of antipsychotic drug classes
which was conducted over 56 weeks in England. This study
tested the hypothesis that second-generation antipsychotics
would be associated with a clinically significant improvement
in quality of life across one year compared with the use of
first-generation antipsychotics. They also examined impact on
patient satisfaction and total health care costs. The study
revealed that there was no disadvantage in terms of quality of
life, symptoms or costs of care in using first-generation antip-
sychotic medications when compared with risperidone, olan-
zapine, quetiapine, and amisulpride.
In patients with first-episode schizophrenia, one study has
attempted to compare the effectiveness of second-genera-
tion antipsychotic drugs, (amisulpride, olanzapine, quetiapine,
and ziprasidone) with that of low-dose haloperidol (mean
dose 3 mg), namely the European First-Episode Schizophrenia
Trial (EUFEST).8 The primary outcome was all-cause discon-
tinuation, and the study population was 489 individuals with
first-episode schizophrenia. Overall, the combined discontin-
uation rate was 47% over one year, varying between 33% for
olanzapine and 72% for haloperidol. In terms of efficacy, it
could not be concluded that second-generation antipsychot-
ics were more efficacious than haloperidol.
Studies that have compared the effectiveness of risperi-
done and haloperidol in the treatment of first-episode psy-
chosis have found that risperidone was more effective,9
prevented relapse for a longer time, and induced less abnor-
mal movements compared to haloperidol.10
From an economic point of view, the largest expense dur-
ing the lifetime of a patient with schizophrenia has always
been inpatient hospitalization. Some epidemiological studies
have found that the second-generation antipsychotics have
reduced rehospitalization by about 12 hospital days per
patient per year.11 There has been one study that examined
the economic outcomes among patients with first-episode
schizophrenia who were treated with second-generation
antipsychotics, (clozapine, olanzapine, quetiapine, risperidone,
and zotepine) compared with each other and haloperidol.12
They found that patients treated with second-generation
antipsychotics had a lower number and shorter duration of
hospitalizations than did patients treated with haloperidol.
Olanzapine was associated with the lowest hospitalization
rate, and economic analysis revealed that individuals pre-
scribed haloperidol were ‘the most expensive’ due to total
hospitalization costs.
This issue is also pertinent in Singapore as hospitalization is
only partially subsidized by the government and lengthy
admissions to hospital could result in a considerable financial
burden on both the patient and their family. So far, there have
been no studies that investigate the impact of either risperi-
done or haloperidol on the length of hospitalization and
three-month outcomes of patients newly diagnosed with
first-episode schizophrenia-spectrum disorders in Singapore.
The need for this study stems from the fact that currently
patients with first-episode psychosis in Singapore can be
started on either a first-generation or a second-generation
antipsychotic medication on admission to hospital.13 This is
different from the clinical practice guidelines recommended
by other countries that state that all first-episode psychosis
patients should be started on a second-generation antipsy-
chotic medication.14,15
It is our hypothesis that commencing a patient newly diag-
nosed with first-episode schizophrenia-spectrum disorders
on haloperidol results in longer duration of stay and poorer
short term outcome than for those patients prescribed
risperidone.
Methods
Data from 77 consecutive inpatients from March 2001–June
2005 accepted into the Early Psychosis Intervention Program
(EPIP) who were initially prescribed either haloperidol or ris-
peridone were included in this naturalistic study in which rat-
ing scales such as the Positive and Negative Syndrome Scale
(PANSS)16 and Global Assessment of Functioning (GAF)17
scale were administered prospectively and any changes to or
discontinuation of medications examined retrospectively.
They were all admitted for the first time to the Institute of
Mental Health/Woodbridge Hospital and fulfilled the follow-
ing criteria: (a) age between 18–40 years; (b) first-episode
schizophrenia-spectrum disorder (schizophrenia, schizo-
phreniform or schizoaffective disorder) with no prior or
minimal treatment; (c) no current history of substance abuse
and (d) no history of major medical or neurological illness.
Risperidone and haloperidol were chosen for this study as
they were the most commonly prescribed second- and first-
generation antipsychotic medications in the program.
EPIP is a comprehensive, integrated and patient-centered
program led by a multidisciplinary team of psychiatrists, psy-
chologists, case managers, social workers, nurses and occupa-
tional therapists. The aims of the program have been to raise
awareness of and reduce stigma associated with psychosis,
establish links with primary health care providers and collabo-
rate in the detection, referral and management of those with
psychosis and to improve the outcome of patients and reduce
the burden of care for their families. Pharmacological man-
agement is based on a treatment algorithm that emphasizes
use of antipsychotic monotherapy (either first- or second-
generation) at low dose.
All patients accepted into EPIP are given an introduction
letter where the EPIP services are described in more detail. In
that same letter, the patients are informed about the collec-
tion of sociodemographic data and administration of clinical
ratings to help evaluate and improve the service. All data is
kept confidential and no individual is identified in the data
analyses. In addition, the EPIP database is registered with and
has been approved by the National Healthcare Group IRB as
a standing database (that is, electronic data stored for the
purposes of patient care/services and/or as a potential
74 Proceedings of Singapore Healthcare 25(2)
resource for future research). As such, individual patient con-
sent is waived.
All patients’ diagnoses were established with the Structured
Clinical Interview for DSM-IV, patient version (SCID-P), and
their socio-demographic data were obtained using a semi-
structured questionnaire. The choice of a particular antipsy-
chotic medication for the patient was based primarily on the
clinical decision of the treating clinician, in discussion with the
patient and family members where possible.
Duration of untreated psychosis (DUP) was defined as the
time in months between onset of psychotic symptoms (delu-
sions, hallucinations and/or disorganized thinking or behavior)
and the time when a definitive diagnosis and treatment were
established. Patients and the primary caregivers were inter-
viewed and asked to date the onset of psychotic symptoms
and the DUP was estimated after combining information from
the interviews and case records. Severity of psychopathology
was assessed by the Positive and Negative Syndrome Scale
(PANSS) and the Global Assessment of Functioning (GAF)
scale used to assess the level of functioning. These assess-
ments are done routinely for all patients of the EPIP on first
presentation (baseline), three months, six months, one year,
and two years later. The ratings were done by experienced
psychiatrists who were trained in the use of these rating
instruments. All raters participated in periodic inter-rater reli-
ability sessions to avoid rater drift.
The primary outcome measurement for effectiveness was
length of hospitalization and PANSS score at three months.
The length of hospitalization was used as a measure of the
overall effectiveness of either haloperidol or risperidone in
treating the acute episode of schizophrenia-spectrum disor-
ders because it was reasoned that the most effective medica-
tion would result in a shorter length of hospitalization. The
total length of hospitalization for each patient was obtained
from the hospital’s electronic data system. The PANSS score
at three months was also considered to be a good measure to
evaluate the effectiveness of either haloperidol or risperi-
done in controlling the acute symptoms of the illness.
A secondary analysis was done to measure the time to dis-
continuation for any reason. This outcome is regularly encoun-
tered in our clinical setting and is a real concern to the clinician
as it could result in a negative outcome for the patient. The
specific reasons for discontinuation of the initial antipsychotic
medication were categorized into (a) lack of efficacy, (b) intol-
erability of side effects (i.e. extrapyramidal side-effects, meta-
bolic dysregulations or any other adverse reactions), (c)
patient’s request, (d) defaulted/non-compliance with treatment
and (e) other reasons (i.e. lack of specific reasons given for dis-
continuation or transferred to other medical facilities). This
data was collected by reviewing patients’ medical records.
Statistical analysis
Descriptive statistics were computed for the basic demo-
graphic and clinical variables. Mean and standard deviations
(SDs) were calculated for continuous variables and frequen-
cies and percentages for categorical variables. Normality of
quantitative data was checked using the Kolmogorov-Smirnov
1-sample test. Differences between the two groups at base-
line were tested by independent t-test and Mann-Whitney U
Table 1.  Socio-demographic characteristics of the sample (n=77).
Variable Mean (SD)
Age (in years) 29.3 (6.8)
Years of schooling 10.9 (3.2)
  n (%)
Gender Male 38 (49.4)
Female 39 (50.6)
Race Chinese 56 (72.7)
Malay 15 (19.5)
Indian 5 (6.5)
Others 1 (1.3)
Marital status Single 62 (80.5)
Married 9 (11.7)
Divorced 6 (7.8)
SD: standard deviation.
test for normal and non-normal continuous variables when-
ever appropriate. Rating scores measured over time (PANSS)
was subjected to repeated measures analysis of variance
(ANOVA) analyses where time effect (within-group factors)
was modeled. Assumptions of the repeated measures
ANOVA including sphericity assumption which was checked
using Mauchly’s test; model fitness was checked by residual
plots and lack-of-fit test. Kaplan-Meier survival curves were
utilized to estimate time to discontinuation for any reason, and
time to discontinuation for specific reasons. A Cox propor-
tional hazards regression model was used to compare the two
treatment groups. Level of significance was set at p value<0.05.
All statistical analyses were performed using SPSS 16.0.
Results
Baseline clinical and demographic
characteristics of patients
Of the 77 patients, 44 (57.1%) patients were prescribed halo-
peridol and 33 (42.9%) patients were on risperidone. As a
whole, the mean age (SD) of the patients was 29.3 (6.8)
years. There were 38 males (49.4%) and 39 females (50.6%).
The majority were Chinese (56/72.7%) and single (62/80.5%).
(Table 1) Their median DUP was 15 months. Their mean
(SD) PANSS total score and GAF scale total score at baseline
were 65.4 (13.7) and 35.4 (14.2), respectively.
There were significant differences between the two groups
in years of education (p value=0.025), age (p value=0.023) and
use of anti-cholinergic medication (p value=0.045). There were
no statistically significant differences between the two groups in
terms of gender (p value=0.742), race (p value=0.577), marital
status (p value=0.708), DUP (p value=0.253), PANSS total
score (p value=0.559), positive score (p value=0.374), GPS
score (p value=0.557), negative score (p value=0.059) and GAF
total score (p value=0.245), symptom score (p value=0.430),
disability score (p value=0.556) at baseline. (Table 2)
Length of stay of first admission
The mean length of stay in days of first admission (SD) was
higher in the risperidone group, 15.8 (8.6) compared to the
Chee et al. 75

Table 2.  Socio-demographic and clinical characteristics compared between those with risperidone (n=33) and haloperidol (n=44).

Variable Risperidone Haloperidol p Value

Mean (SD) Mean (SD)

Age (in years) 27.4 (6.1) 30.7 (7.0) 0.023
Years of schooling 11.8 (2.8) 10.2 (3.3) 0.025
  n (%) n (%)  
Gender Male 17 (51.5) 21 (47.7) 0.742
Female 16 (48.5) 23 (52.3)
Race Chinese 25 (75.8) 31 (70.5) 0.577
Malay 5 (15.2) 10 (22.7)
Indian 2 (6.1) 3 (6.8)
Others 1 (3.0) 0 (0)
Marital status Single 28 (84.8) 34 (77.3) 0.708
Married 3 (9.1) 6 (13.6)
Divorced 2 (6.1) 4 (9.1)
Anticholinergic medication Yes 14 (43.8) 29 (65.9) 0.045
(at 3 months) No 18 (56.3) 15 (34.1)  
  Mean (SD) Mean (SD)  
PANSS score baseline Total 66.1 (13.9) 64.8 (13.8) 0.559
  Positive 19.5 (4.5) 20.3 (5.0) 0.374
  Negative 14 (7.3) 12.7 (8.6) 0.059
  GPS 32.6 (8.1) 32.0 (7.6) 0.557
PANSS score month 3 Total 35.4 (8.6) 38.6 (10.1) 0.084
  Positive 8.4 (2.9) 8.5 (3.1) 0.924
  Negative 8.0 (2.2) 9.7 (4.8) 0.100
  GPS 19.0 (4.7) 20.5 (4.8) 0.079
GAF baseline Total 38.0 (15.2) 33.5 (13.2) 0.245
DUP 36.5 (15.9) 33.2 (13.8) 0.253
Length of stay of 1st admission 15.8 (8.6) 15.6 (9.2) 0.951

GAF: Global Assessment of Functioning; PANSS: Positive and Negative Syndrome Scale; SD: standard deviation.

haloperidol group, 15.6 (9.2). However, this difference was
not statistically significant (p value=0.951)
Total PANSS score at three months
Figure 1 shows the effects of medication on PANSS scores.
The PANSS (SD) total score at three months for the patients
on haloperidol and for those on risperidone was 38.6 (10.1)
and 35.4 (8.6) respectively. The difference was not statistically
significant (p value=0.084). Over the three-month period,
there were significant reductions in PANSS total (p value
<0.001), positive (p value<0.001), negative (p value<0.001)
and general psychopathology scores (p value<0.001) among
those taking haloperidol and risperidone. However, in terms
of time-group interaction effect, there were no significant dif-
ferences between the groups in PANSS total, PANSS positive
and PANSS GPS scores. There was a significant difference in
the reduction in PANSS negative scores between the two
groups, with the risperidone group showing a greater reduc-
tion in scores at three months (p value=0.05).
Discontinuation of treatment
As a whole, 40 (51.9%) of patients discontinued their antipsy-
chotic medication for any reason within three months. As a
group, the mean survival time for prescribing risperidone and
haloperidol was 44.9 days (95% confidence interval (CI):
23.9–65.9) and 17.6 days (95% CI: 9.7–25.5), respectively.
The median survival time for prescribing risperidone and
haloperidol was 43 days (95% CI: 0.9–85.1) and 11 days (95%
CI: 7.2–14.8) respectively (Figure 2). Those on haloperidol
had a two-fold higher risk (hazard ratio=2.7; CI: 1.2–6.0,
p=0.018) of discontinuing their antipsychotic medication for
any reason compared to those prescribed risperidone.
Of those who discontinued haloperidol, 28.6% did so due
to lack of efficacy compared to 25.0% in the risperidone
group who discontinued their medication for the same rea-
son. The proportion of those who discontinued their medica-
tion for reasons of intolerability of side effects was 50.0% in
the haloperidol group and 25.0% in the risperidone group.
Discussion
The findings suggest that there is no significant difference in
length of first admission between the two groups and total
PANSS at three months; however it was found that patients
on risperidone had a more significant decrease in PANSS
negative scores at three months and a longer time to treat-
ment discontinuation.
Baseline characteristics of patients
Although there were statistically significant differences
between the two groups in terms of age and years of edu-
cation, this was not considered clinically relevant. Otherwise,
the two groups were comparable to each other.
76 Proceedings of Singapore Healthcare 25(2)
Figure 1.  Mean Positive and Negative Syndrome Scale (PANSS) scores over three months showing (a) total scores; (b) positive; (c)
negative; and (d) GPS scores.
Length of admission
It is interesting that the length of admission for both groups
was not statistically significant as other studies have shown
that risperidone may reduce the total hospitalization cost
compared to first-generation antipsychotic medication.18 This
finding may not be applicable as the patient population in that
particular study had chronic schizophrenia whereas the
patients in this study were all newly diagnosed with first-
episode schizophrenia-spectrum disorders.
Short-term response to treatment
With regards to the finding that there was no significant dif-
ference in total PANSS score at three months between the
two groups; this echoes several studies, such as the CATIE
and EUFEST studies discussed earlier that found there was no
difference in efficacy between first- and second-generation
antipsychotic medication. A recent meta-analysis of first- ver-
sus second-generation antipsychotic medication in first-epi-
sode psychosis found that there were no differences in either
discontinuation rates or symptom efficacy.19
A randomized controlled trial that examined short-term
outcomes in patients with first-episode schizophrenia started
on either haloperidol or risperidone found that at the end of
eight weeks, there were significantly fewer drop-outs and
longer discontinuation time in the risperidone group com-
pared to the haloperidol group. Both haloperidol and risperi-
done appeared to be equally effective in treating negative and
other symptoms of first-episode schizophrenia.20
The negative symptoms of schizophrenia, namely apathy,
social withdrawal, paucity of speech, and blunted affect, are
difficult to treat and are said to contribute more to poor
functional outcome and quality of life for patients with schiz-
ophrenia than do positive symptoms.21 In this study, risperi-
done was found to cause a statistically significant reduction in
PANSS negative scores compared to haloperidol. This is con-
sistent with its more potent action as a 5-HT2 receptor
antagonist. In a study comparing risperidone and chlorprom-
azine, it was found that both medications significantly
decreased the positive and general symptoms of patients
with schizophrenia, but risperidone was more effective in
treating negative symptoms.22 It is possible that risperidone’s
propensity to cause less extrapyramidal side-effects also
played a part in reducing the PANSS negative scores com-
pared to haloperidol.
Discontinuation of treatment
Discontinuation of treatment for whatever reason remains a
challenge to the clinician who treats patients with schizophre-
nia. As previous studies such as the CATIE study have shown,
Chee et al. 77
Figure 2.  Days of discontinuation between those with haloperidol and risperidone medication.
discontinuation rates are very high and ultimately lead to a
poor prognosis in this group of patients. One study examining
the relapse rate in people in the five years after their first
hospitalization for a psychotic illness found that it was over
80% and the two main independent risk factors predicting
relapse were poor adherence to prescribed antipsychotic
medication and pre-morbid level of functioning.23 A longer
time to discontinuation is strongly associated with better
symptomatic improvement24 and functional outcome,25
which makes the choice of which antipsychotic to initiate all
the more important.
Treatment effectiveness can be subdivided into the con-
stituents of efficacy, tolerability, and adherence. Efficacy is a
crucial component, but an efficacious treatment only works if
it is acceptable and used on a regular basis by the patient. In
this study, the time to discontinuation for risperidone was
longer compared to haloperidol.
The two main reasons for discontinuation in this study
were lack of efficacy and lack of tolerability of side-effects.
This finding has been replicated in other studies, which found
that there was better adherence to and tolerability for sec-
ond-generation antipsychotics than for low-dose first-gener-
ation antipsychotics in first-episode psychosis.26 In terms of
discontinuation due to lack of efficacy, patients were switched
to a different antipsychotic as soon as it was apparent that
they were not responding to either haloperidol or risperi-
done by 4–6 weeks of treatment. This is in line with the pro-
gram’s treatment algorithm which is based on studies that
show early response is a significant predictor of response
and remission later on.27
Side-effects do play a large part in determining adherence
to medications, and in the case of first-generation antipsy-
chotic medications, their propensity to cause extrapyramidal
side-effects has shown to lead to earlier discontinuation of
treatment.28 In this study, the number of patients on anticho-
linergic medication was higher in the haloperidol group, indi-
cating that they were experiencing more extrapyramidal side
effects compared to those on risperidone. This in turn led to
a significant number of them discontinuing their medications
within three months.
There was a relatively significant proportion of patients
in this study who fell into the category of discontinuation of
medications due to other reasons. The possible explana-
tions for this could be cultural factors within the Asian pop-
ulation. For example it is still common to attribute mental
illness to the workings of spirits or black magic.29 Also, being
diagnosed with a mental illness leads to considerable stigma-
tization within society and this will influence a person’s will-
ingness to seek or maintain psychiatric treatment.30
Limitations
There are limitations to this study. Firstly, this is a naturalis-
tic and retrospective study. As a result, inevitable biases
that are present in real world clinical situations exist; for
example, patients’ and clinicians’ notions of their antipsy-
chotic medications and different clinicians’ thresholds in
switching medication. Second, the number of patients stud-
ied was quite small. A larger sample may have rendered
more significant results. As this was a naturalistic study,
patients were allowed to be on other non-antipsychotic
medications and drug-drug interactions between combina-
tions of these medications could lead to adverse side-
effects that would not be attributable solely to the
antipsychotic medications per se. Thirdly, as the discontinu-
ation rate was high in both groups, it is difficult to comment
78 Proceedings of Singapore Healthcare 25(2)
on the difference or lack of difference in short-term effi-
cacy between the two medications.
Strengths
This is the first naturalistic study of Asian patients admitted
with first-episode schizophrenia-spectrum disorders that
looks into the difference in short-term outcome when start-
ing a first- or second generation antipsychotic medication.
Conclusion
It is without a doubt that the introduction of antipsychotic
medications has radically changed the treatment and out-
come of patients with schizophrenia.31 The studies discussed
earlier point to the fact that there does not seem to be a
differential efficacy between first- and second-generation
antipsychotics and that good management of the patients,
regardless of which antipsychotic is used, will eventually
make the difference in outcome. The latest recommenda-
tions from the British Association of Psychopharmacology
on the treatment of schizophrenia focuses on side effects
rather than class of antipsychotic, and recommends low
starting doses in first-episode psychosis with careful side
effect monitoring.32
This study found that there was no difference between
haloperidol and risperidone when it came to treating the first
admission for first-episode schizophrenia-spectrum disorders
and outcome at three months; however, risperidone did
seem to have a better effect on negative symptoms and was
better tolerated, resulting in a longer time to discontinuation
for any reason. Thus, in terms of the clinical relevance of this
study, our findings suggest that starting a patient with first-
episode schizophrenia-spectrum disorders on risperidone
will lead to a better short-term outcome as compared to
starting the same patient on haloperidol. Ultimately, clinicians
will continue to base prescribing decisions on a variety of
rational and non-rational factors, but it is of most importance
to individualize treatment selection by considering patient-
and medication-related factors.
Declaration of Conflicting Interest
The authors declare that there is no conflict of interest.
Funding
This paper was written without any funding from any source and the
authors have no industrial links or affiliations.
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