Evaluation of Paliperidone in Improving Patient Positive Symptoms vs NegativeSymptoms in an Inpatient Psychiatric Facility

Background. The FDA approval of risperidone turned 1st line treatment for schizophrenia to the atypicals due to their propensity to control both positive and negative symptoms and having a better side effect profile. Paliperidone is the first antipsychotic that is an active metabolite. Purpose. The main goal of this study is to evaluate the efficacy and safety of paliperidone in an actual clinical setting while comparing the improvements specifically to schizophrenia positive or negative symptoms. This evaluation will help determine if the paliperidone treatment is equally effective in both symptom clusters. To evaluate these outcomes, the 24-item Brief Psychiatric Rating Scale (BPRS) will be utilized. Methods. Chart reviews of 73 psychiatric patients while on paliperidone between March 1, 2006 and April 1, 2009 were reviewed. BPRS scores prior to paliperidone treatment, at 1 month, 3 months, 6 months, and last recorded while on paliperidone were recorded. Results. The negative cluster of the BPRS (blunted affect, emotional withdrawal, and motor retardation) showed an average of 3.7% decrease with no statistical significance. The positive cluster (hostility, grandiosity, hallucinations, excitement, suspiciousness, and conceptual disorganization) had a 16.7% decrease in BPRS, a total decrease of 177 points from baseline to last recorded and overall showed a statistical significance in both the 1-tailed and 2-tailed Paired T-Test. Conclusion. Paliperidone showed a much higher efficacy in reducing the positive cluster symptoms of schizophrenia but showed little to no statistical significance in reducing the negative cluster symptoms.