My concern is that this study could be used to support the use of risperidone in refractory (as opposed to intolerant) patients, resulting in the delayed use of clozapine. Of greater concern could be its use as a justification to switch patients from clozapine to risperidone, which could lead to serious exacerbations of illness. It is clear that risperidone is an effective antipsychotic that is better tolerated by patients who experience extrapyramidal symptoms while taking standard agents. At present, there is no convincing evidence of its efficacy in treatment-refractory patients. Clozapine remains unique in this regard.