The impact of long-acting injectable vs. oral risperidone on cognition and work functioning after an initial psychotic episode: the critical role of early medication adherence

Presentation First Author: 
Keith Nuechterlein

Background: Cognitive deficits are a critical target for attempts to improve everyday functioning in schizophrenia. Although most studies have shown only modest effects of second-generation antipsychotic medications on cognitive deficits, they have typically focused on chronic phases of schizophrenia without considering medication adherence. Method: A 12-month, open-label, randomized controlled trial of long-acting injectable risperidone (RLAI) vs. oral risperidone is focusing on the impact of medication adherence after an initial episode of schizophrenia. The medication randomization was in the context of providing supported employment/education to all participants. Analyses involved 61 patients who were randomized to RLAI vs. oral risperidone at least 6 months prior to these analyses, 57 of whom had completed assessments at the 6-month point. Results: On the MATRICS Consensus Cognitive Battery (MCCB), RLAI led to significantly greater improvement than oral risperidone in verbal learning and a similar non-significant tendency for working memory and the overall composite score. A dimension of medication adherence rated across the RLAI and oral groups was significantly predictive of cognitive improvement from baseline to 6 months in the overall composite score and the cognitive domains of working memory and visual learning. Work/school functioning also improved significantly more with RLAI compared to oral risperidone. Conclusions: Consistent use of a second-generation antipsychotic medication improves cognition and work functioning in the early course of schizophrenia more than has been appreciated. Although long-acting injectable antipsychotic medication has typically not been used with first-episode schizophrenia patients, it may have notable advantages.

Conference Name: 
Presentation Date: 
January, 2013
Additional Authors: 
Keith Nuechterlein, Kenneth Subotnik, Joseph Ventura, Denise Gretchen-Doorly, Laurie Casaus, John Luo, Nicole DeTore, Andres Victoria, Andrew Kurtz
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