Risperidone for AIDS-Associated Dementia: A Case Series

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Abstract
Objective To determine the effect of low-dose risperidone on behavioral disturbances associated with AIDS dementia in young-to-middle-age nursing home patients. Neuroleptics are commonly used for behavioral control in this population, but these drugs often fail to control symptoms, and carry a high risk of movement disorders.1,2 Because the AIDS virus attacks the basal ganglia, these patients are highly susceptible to neuroleptic-induced movement disorders that increase the risk of falling.1 However, low-dose risperidone reportedly carries little risk of movement disorders.3 Method Nine nursing home patients with AIDS dementia received risperidone for behavioral disturbances (psychomotor agitation, aggressiveness, social withdrawal, uncooperativeness) or psychotic symptoms. Seven were switched to risperidone because their symptoms were unresponsive to conventional neuroleptics and adjunct benzodiazepines, antidepressants, or methylphenidate. One patient was switched because of a neuroleptic-induced movement disorder, and one had no history of antipsychotic medication. Patients were followed up only for periods ranging from 2 weeks to 4 months, because AIDS dementia is a terminal-stage condition for AIDS patients. Results Patients varied in age from 28 to 57 years. Risperidone dosages ranged from 0.5 mg daily to 1 mg twice daily. Most patients received an adjunct benzodiazepine, antidepressant, or mood stabilizer. Within a week or so after starting risperidone, six of the nine patients exhibited brighter mood, were less agitated or aggressive and more cooperative, and participated more frequently in social activities. Two patients became increasingly agitated or psychotic, and came under control only after risperidone was stopped and replaced with haloperidol. One patient was transferred to a psychiatric unit, because of increased paranoid delusions and auditory hallucinations. Conclusions Risperidone effectively controlled behavioral disturbances associated with AIDS dementia in 6 of 9 patients. Risperidone may be an alternative to conventional neuroleptics in patients susceptible to neuroleptic-induced movement disorders or unresponsive to neuroleptics and adjunct psychotropic agents.

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