Risperidone-induced Oculogyric Crisis

Sir, Risperidone in low doses (< 6 mg) is reported to be relatively free from extrapyramidal side effects including dystonia, akathisia, druginduced parkinsonism and tardive dyskinesia (Thomas and Lewis, 1998). A double blind study, which included 388 schizophrenic patients drawn from 20 sites in the United States, reported that the incidence of extrapyramidal symptoms in patients receiving 6 mg of risperidone was no higher than that in patients receiving placebo (Marder and Meibach.1994) To our knowledge, few cases of dystonic reactions and one case of oculogyric crisis (OGC) as part of the dystonic reaction during risperidone treatment have been reported in the literature (Dickson et al.,1994; Radford et al.,1995; Faulk et al ,1996). We report two patients with schizophrenia who developed OGC crises during risperidone treatment Case 1: Ms. A, a 22-year-old girl with DSM-IV paranoid schizophrenia for 8 months was hospitalised and treatment was initiated in the form of risperidone 1 mg b i d on first day and 2 mg b id . from second day onwards Patient did not receive any concomitant medication except lorazepam 2 mg h.s. After four days of treatment with risperidone, Ms A started having repeated episodes of upward deviation and fixation of eyeballs, with no other associated dystonic reaction, which would be relieved after giving promethazine, 25 mg i.m. Tablet trihexyphenidyl 2 mg t. id. was added which successfully prevented these episodes Case 2: Mrs. S, a 40-year-old lady with DSM-IV undifferentiated schizophrenia for 17 years presented with prominent negative symptoms. During 17 years of her illness, she received trials of various antipsycotics including chlorpromazine, haloperidol, trifluoperazine and fluphenazme decanoate without significant improvement in negative symptoms After hospitalisation, previous medications were gradually discontinued and risperidone was started with gradual dosage increment, i.e. 1 mg b i d on first day, 2mg b i d on second day and 3 mg b i d then on. On the sixth day of treatment, she developed episodes of upward fixed gaze, which used to subside on giving promethazine, 25mg i.m. The frequency of such episodes did