Publication:

A comparative study of the safety of risperidone with olanzapine in patients of new-onset psychosis

Background Patients with new-onset psychosis are particularly sensitive to adverse effects of antipsychotic medications, which may influence treatment adherence and long-term outcomes. Risperidone and olanzapine are commonly used second-generation antipsychotics with differing safety profiles. This study aimed to compare the safety of risperidone and olanzapine in patients with new-onset psychosis using standardized assessment tools.

Methods A prospective, randomized, open-label comparative study was conducted in a tertiary care hospital in the sub-Himalayan region of India. Seventy-four consenting adults with newly diagnosed psychosis were randomized into two groups: risperidone (2-8 mg/day, n=36) and olanzapine (5-30 mg/day, n=38). Participants were followed for six months with assessments at baseline, 1, 3, and 6 months. Safety evaluation included clinical adverse effects, biochemical parameters, and extrapyramidal symptoms using the abnormal involuntary movement scale (AIMS) and extrapyramidal symptom rating scale (ESRS).

Results Baseline characteristics were comparable between groups. Both treatments were associated with weight gain, with a greater metabolic impact observed in the olanzapine group. Significant increases in blood glucose and lipid parameters were noted with olanzapine at six months compared with risperidone (p<0.05). Liver enzyme elevations were more frequent with olanzapine but remained clinically manageable. Extrapyramidal symptoms were more pronounced in the risperidone group, particularly during early treatment, as reflected by higher AIMS and ESRS scores. Most adverse effects were mild to moderate and improved over time.

Conclusions Both risperidone and olanzapine are relatively safe in new-onset psychosis but exhibit distinct adverse-effect profiles. Olanzapine is associated with greater metabolic disturbances, whereas risperidone shows a higher propensity for extrapyramidal symptoms. Individualized drug selection with appropriate monitoring is essential to optimize treatment outcomes.