Discussion
chronic disorder, RS, psychotic, depressive, Parkinson’s disease, EPS, depressive symptoms, psychotic symptoms
CHRONIC DISORDER, ADVERSE EFFECTS
The main findings of this study were that (1) after 6 months of treatment, low-dose risperidone in combination with sertraline was more efficacious than standard-dose risperidone alone in terms of psychotic symptoms and depressive symptoms; (2) the RS group was more efficacious than the control group in terms of improvement in psychosocial functioning; (3) the RS group had fewer adverse effects than the control group, including prolactin levels and EPS symptoms; and (4) improvement in psychosocial functioning was associated with changes in clinical symptoms and prolactin levels.We found that low-dose risperidone combined with sertraline treatment for 24 weeks was more effective than risperidone monotherapy in alleviating negative symptoms, improving social functioning and reducing side effects in patients with FEMN SZ. That is, 24 weeks of low-dose risperidone combined with sertraline not only improved the efficacy in patients with FEMN SZ but also reduced adverse effects, such as elevated EPS and serum prolactin, thereby improving the safety of risperidone in FEMN patients. Furthermore, in line with other studies, the addition of sertraline was effective in improving depressive symptoms in SZ patients [We hypothesize that the better efficacy of the combination of antipsychotics for SZ is due to the modulatory effect of sertraline on the 5-HT system. The effect of risperidone on the brain is mainly to reduce the activity of the dopaminergic pathway, thus reducing psychotic symptoms [Notably, we found lower adverse effects in the RS group, including prolactin levels and EPS symptoms than with risperidone monotherapy. Evidence supports that high dose of atypical antipsychotics (e.g. olanzapine or risperidone) causes adverse effects in Parkinson’s disease at rates similar to those of low potency typical antipsychotics (chlorpromazine) [This study also demonstrated that risperidone combined with sertraline significantly improved psychosocial functioning in FEMN patients with SZ. In addition, improvements in psychotic symptoms, depressive symptoms, and changes in serum prolactin levels were associated with improvements in psychosocial functioning. Patients with SZ usually show deficits in various psychosocial domains, such as the quality of social relationships, self-care abilities, and occupational domains [In the present study, we noted some limitations. The first limitation was that this was not completely a double-blind placebo-controlled study. Although the nurses did not tell the patients what medications they were taking and the patients did not mutually know the number of capsules used, the patients may have identified the intervention because the RS group took two capsules and the control group took one capsule. Second, a study design comprises 4 groups, including regular dose risperidone monotherapy, low-dose risperidone monotherapy, regular dose risperidone plus sertraline, and low-dose risperidone plus sertraline will be better to answer if sertraline can have additional benefits, either with a better effect on improved psychotic/affective symptoms or lower adverse effects. Third, this study was a 24 week clinical trial, which is too short to draw firm conclusions. In particular, in this study, sertraline was administrated during psychotic onset and not throughout the whole treatment of SZ, which is a chronic disorder that usually requires long-term treatment with antipsychotics. Therefore, since the investigation was conducted solely during the first 24 weeks of treatment, there should not be any generalizations beyond this period. Fourth, another limitation was to extrapolate the results obtained on every other antipsychotic medication, as they can significantly differ in their mechanisms of action. Fifth, the study population was limited to Asians, which may limit the generalization of the findings in this study to other populations.In conclusion, the present study suggests that low-dose risperidone combined with sertraline has a better therapeutic effect on psychotic symptoms and social functioning in FEMN SZ patients than standard doses of risperidone alone. Our study is the first to report that sertraline combined with low-dose risperidone is superior to conventional therapeutic doses of risperidone, providing a new and clinically meaningful contribution to the treatment of the early stages of SZ. These findings are promising, however, further multicenter studies of antipsychotic drug combinations in patients with FEMN SZ are warranted to confirm the preliminary findings.