Effects of Clozapine Add-On to Risperidone vs. Risperidone Monotherapy on Agitation in Paranoid Schizophrenia: A Quasi-experimental Pilot Study
| Author | Najmiatul Fitria | en |
| Author | Hidayatul Arief | en |
| Author | Yelly Oktavia Sari | en |
| Author | Syofyan Syofyan | en |
| Orcid | Najmiatul Fitria [0000-0002-3255-1961] | en |
| Orcid | Hidayatul Arief [0009-0006-3554-9855] | en |
| Orcid | Yelly Oktavia Sari [0000-0002-8471-7054] | en |
| Orcid | Syofyan Syofyan [0000-0002-9803-1870] | en |
| Issued Date | 2026-03-31 | en |
| Abstract | Background: Second-generation antipsychotics, including risperidone and clozapine, are widely used for paranoid schizophrenia. Clozapine is typically considered in treatment-resistant cases, but the evidence for add-on therapy in agitation symptoms remains limited. Objectives: This study aimed to compare the effects of risperidone monotherapy versus risperidone plus clozapine add-on therapy on agitation symptoms in patients with paranoid schizophrenia. Methods: A retrospective observational quasi-experimental study was conducted at a psychiatric unit in West Sumatra, Indonesia, from January to December 2023. A total of 47 inpatients diagnosed with paranoid schizophrenia were included: Thirty-eight received risperidone monotherapy and 9 received risperidone plus clozapine combination therapy. Agitation was assessed using the Positive and Negative Syndrome Scale-Excited Component (PANSS-EC) in its validated Indonesian version. Sociodemographic characteristics and PANSS-EC score changes were analyzed using non-parametric tests. Results: Both treatment groups showed reductions in PANSS-EC scores. The risperidone monotherapy group showed a mean reduction of 4.26 ± 3.20 points, while the combination therapy group showed a slightly higher mean reduction, although the difference was not statistically significant. The mean length of hospitalization was 20.95 ± 6.18 days for the risperidone group and 20.00 ± 4.69 days for the combination group (P = 0.878). No significant associations were found between sociodemographic variables and agitation improvement. Conclusions: Clozapine add-on to risperidone showed a non-significant trend toward greater reduction in agitation symptoms compared to risperidone alone. However, the small and unequal sample sizes, lack of dosage and adherence data, and short follow-up limited the strength and generalizability of the findings. Future prospective studies with larger samples, standardized dosage reporting, and longer-term follow-up are needed. | en |
| DOI | https://doi.org/10.5812/ijpbs-164189 | en |
| URI | https://brieflands.com/journals/ijpbs/articles/164189 | en |
| Keyword | Agitation | en |
| Keyword | Clozapine | en |
| Keyword | Quasi-experimental | en |
| Keyword | Risperidone | en |
| Keyword | Schizophrenia | en |
| Publisher | Brieflands | en |
| Title | Effects of Clozapine Add-On to Risperidone vs. Risperidone Monotherapy on Agitation in Paranoid Schizophrenia: A Quasi-experimental Pilot Study | en |
| Type | Research Article | en |
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