Risperidone in the Treatment of Psychotic-like and Deficit Symptoms of Schizotypal Personality Disorder

This study has been completed.
Sponsor:
Collaborator:
Janssen Pharmaceutica
Information provided by (Responsible Party):
Harold W Koenigsberg, Icahn School of Medicine at Mount Sinai
ClinicalTrials.gov Identifier:
NCT00158028
First received: September 8, 2005
Last updated: August 2, 2016
Last verified: August 2016
  Purpose
The purpose of this study is to determine the efficacy of risperidone compared to placebo in the treatment of the psychotic-like and deficit symptoms of schizotypal personality disorder (SPD). Treatment with risperidone, a 5HT2 and dopamine D2 blocking agent, holds particular promise in the treatment of SPD. Unlike traditional antipsychotics, risperidone targets the deficit or negative symptoms of schizophrenia. The deficit-like symptoms of SPD are therefore also likely respond to treatment with risperidone. One common complication in the present psychopharmacologic treatment of SPD with traditional neuroleptics is the fact that many patients discontinue treatment due to the medication-induced dysphoria. Given initial reports and the serotonergic component of the risperidone mechanism, risperidone is anticipated to produce little or no dysphoria.

Condition Intervention
Schizotypal Personality Disorder
Drug: Risperidone
Drug: Placebo

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Investigator)
Primary Purpose: Treatment
Official Title: Risperidone in the Treatment of Psychotic-like and Deficit Symptoms of Schizotypal Personality Disorder

Resource links provided by NLM:


Further study details as provided by Icahn School of Medicine at Mount Sinai:

Primary Outcome Measures:
  • Positive and Negative Symptom Scale (PANAS) rating

Secondary Outcome Measures:
  • Clinical global Impression, Schizotypal Persoality Questionarre Score, CPT-IP, Paced Auditory Serial Addition Task, Wechsler memory scale-Revised Visual Reproduction; Serial Verbal Learning Test

Enrollment: 25
Study Start Date: November 1995
Study Completion Date: December 2001
Primary Completion Date: December 2001 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Risperidone
starting dose 0.25mg/day, titrated upward to 2mg/day over 9 weeks
Drug: Risperidone
The dosage of risperidone was titrated upward in a stepwise design, beginning with 0.25 mg/d for the first week, 0.5 mg/d for weeks 2 and 3, 1.0 mg/d for weeks 4 and 5, 1.5 mg/d for weeks 6 and 7, and 2.0 mg/d for the remaining weeks.
Placebo Comparator: Placebo
placebo match in identical tablets
Drug: Placebo
placebo match in identical tablets

  Hide Detailed Description

Detailed Description:

All patients receive a comprehensive medical evaluation prior to their participation in any studies, as part of their normal clinical care. The evaluation includes an extensive medical history, physical examination, and laboratory evaluation including SMA-18, CBC with differential, TFT's, U/A, stool guaiac, serology, drug screen, chest X-ray (where indicated), EKG, and, for women, pregnancy test. [Note: Subjects will have consented to these procedures in a separate consent, "Biological Correlates of Personality Disorder- Information for Subjects (88244)", before being invited to join this study.] Patients will be interviewed by clinical psychology doctoral students trained in the use of structured instruments to assess Axis I and Axis II pathology. A rater will independently complete either the Schedule for Affective Disorders and Schizophrenia (SADS) (Spitzer & Endicott 1978), modified for evaluation of DSM-IV criteria for Axis 1 disorders, or the Structured Clinical Interview for DSM-IV Axis I Disorders ( First et al 1996) and the Structured Interview for DSM-III-R Personality Disorders (SIDP-R) (Pfohl et al 1989) also modified for the evaluation of DSM-IV criteria. When possible, information will be gathered independently from an informant (first degree relative or life-long friend) to supplement information obtained from clinical interviews and review of past records. The use of structured interviews, and questionnaires are not part of standard clinical care.

PART 1 Part 1 is a single-blind two-week placebo washout. Patients will be seen weekly by a research psychiatrist. One week of (placebo) medication will be dispensed at a time by a research program physician under the direct supervision of Dr. Koenigsberg. Patients will be seen weekly throughout the study. Interviews and assessments are standardized and identical throughout all phases of the study. They include the Clinical Global Impression scale (CGI), the Scale for the Assessment of Negative Symptoms (SANS), the Positive and Negative Symptom Scale (PANSS), and the Hamilton Depression Rating Scale (HDRS), all administered weekly. At baseline and after 4- and 9-weeks of treatment, subjects will also receive a series of paper-and-pencil and computer-presented cognitive tests (DOT test, Paced Auditory Serial Addition Task, Continuous Performance Task-Identical Pairs version, Serial Verbal Learning Test and the Wechsler memory Scale-Revised Visual Reproduction test). No medications, other than study drug, are allowed during the protocol. If, during this two-week placebo washout period, the total SANS score decreases by 35% or greater, patients will not be entered into Phase 2. Use of a placebo washout is not part of standard clinical care.

PART 2 Part 2 is the double blind, 9-week parallel-arm placebo-controlled portion of the study. Randomization will be conducted by the Pharmacy. One week of medication (active or placebo) will be dispensed at a time by a research program physician under the direct supervision of Dr. Koenigsberg. The patient will receive 1 tablet PO QD every day of the study. If enrolled in the Active Arm of the study, the patient will receive a .25 mg risperidone tablet orally once daily for Days 1 to 7; .5 mg risperidone tablet orally once daily for Days 8 to 21; 1 mg risperidone tablet orally once daily for Days 22-35; 1.5 mg risperidone tablet orally once daily for days 36-49; and a 2 mgs of risperidone orally once daily for days 50 to 63. If the treating psychiatrist believes that a higher dose is clinically indicated, the physician may alter the above by increasing the dose to 2 mg per day beginning on day 22 and to 4 mg per day beginning on day 50. Weekly visits will include standard assessment and review of protocol compliance. Treatment with risperidone is not part of current standard clinical care of schizotypal personality disorder and this study is designed to establish its usefulness with this population. Similarly use of a double bind placebo control is not part of standard clinical care.

PART 3 Patients who were randomized into the placebo arm of Part 2 will be offered the opportunity of participating in an 8 week open label study of risperidone otherwise identical to Part 2.

Data will be analyzed by a repeated measures analysis of variance separately for scores on the CGI, SANS, PANSS, and HDSR comparing placebo and active medication.

  Eligibility

Ages Eligible for Study:   18 Years to 65 Years   (Adult)
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

Schizotypal Personality Disorder

Exclusion Criteria:

Over 65

  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00158028

Locations
United States, New York
Bronx VA
Bronx, New York, United States, 10029
Sponsors and Collaborators
Icahn School of Medicine at Mount Sinai
Janssen Pharmaceutica
Investigators
Principal Investigator: Harold Koenigsberg Mount Sinai School of Medicine/Bronx VA
  More Information

Publications:
Responsible Party: Harold W Koenigsberg, Professor, Icahn School of Medicine at Mount Sinai
ClinicalTrials.gov Identifier: NCT00158028     History of Changes
Other Study ID Numbers: GCO 94-561 
Study First Received: September 8, 2005
Last Updated: August 2, 2016
Health Authority: United States: Food and Drug Administration

Keywords provided by Icahn School of Medicine at Mount Sinai:
Schizotypal Personality Disorder
Risperidone
Treatment
Cognitive

Additional relevant MeSH terms:
Disease
Personality Disorders
Schizotypal Personality Disorder
Pathologic Processes
Mental Disorders
Risperidone
Serotonin Antagonists
Serotonin Agents
Neurotransmitter Agents
Molecular Mechanisms of Pharmacological Action
Physiological Effects of Drugs
Antipsychotic Agents
Tranquilizing Agents
Central Nervous System Depressants
Psychotropic Drugs
Dopamine Antagonists
Dopamine Agents

ClinicalTrials.gov processed this record on August 23, 2016