A Randomized Controlled Trial of Risperidone in the Treatment of Aggression in Hospitalized Adolescents With Subaverage Cognitive Abilities

Buitelaar, Jan K.; Gaag, Rutger Jan van der; Cohen-Kettenis, Peggy; Melman, Caroline

doi:10.4088/jcp.v62n0405

Cited by 206 publications

(99 citation statements)

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“…This limitation notwithstanding, the relatively low mean dose (approximately 2.0 mg/day) of risperidone used in this study was effective in managing the specific target symptoms of aggression, agitation, and self-injury. This mean dose was remarkably similar to the doses in several other studies (16,22,27,28). The possibility of solidifying these gains or even extending the benefit of risperidone treatment by combining it with behavior therapy was not explored in this investigation but is an important research question for future studies.…”

Section: Discussionsupporting

confidence: 78%

Risperidone Treatment of Autistic Disorder: Longer-Term Benefits and Blinded Discontinuation After 6 Months

Aman¹,

Arnold²,

Lindsay³

et al. 2005

AJP

251

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Objective: Risperidone is effective for short-term treatment of aggression, temper outbursts, and self-injurious behavior in children with autism. Because these behaviors may be chronic, there is a need to establish the efficacy and safety of longer-term treatment with this agent.Method: The authors conducted a multisite, two-part study of risperidone in children ages 5 to 17 years with autism accompanied by severe tantrums, aggression, and/or self-injurious behavior who showed a positive response in an earlier 8-week trial. Part I consisted of 4-month open-label treatment with risperidone, starting at the established optimal dose; part II was an 8-week randomized, double-blind, placebo-substitution study of risperidone withdrawal. Primary outcome measures were the Aberrant Behavior Checklist irritability subscale and the Clinical Global Impression improvement scale.Results: Part I included 63 children. The mean risperidone dose was 1.96 mg/day at entry and remained stable over 16 weeks of open treatment. The change on the Aberrant Behavior Checklist irritability subscale was small and clinically insignificant. Reasons for discontinuation of part I included loss of efficacy (N=5) and adverse effects (N=1). The subjects gained an average of 5.1 kg. Part II included 32 patients. The relapse rates were 62.5% for gradual placebo substitution and 12.5% for continued risperidone; this difference was statistically significant.Conclusions: Risperidone showed persistent efficacy and good tolerability for intermediate-length treatment of children with autism characterized by tantrums, aggression, and/or self-injurious behavior. Discontinuation after 6 months was associated with a rapid return of disruptive and aggressive behavior in most subjects.

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Section: Discussionsupporting

confidence: 78%

Risperidone Treatment of Autistic Disorder: Longer-Term Benefits and Blinded Discontinuation After 6 Months

Aman¹,

Arnold²,

Lindsay³

et al. 2005

AJP

251

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“…Study of a broad sample of children whose psychotic symptoms occur in multiple diagnostic contexts may increase the generalizability of results. In addition, it is important to determine the safety and tolerability of relatively high doses of the newer medications in the pediatric population, given the growing awareness of the increased risk of atypical antipsychoticassociated diabetes in adults (Henderson, 2002;Newcomer et al, 2002;Sernyak et al, 2002;Wirshing et al, 1998), case reports describing significant side effects when atypicals are used in children and adolescents (Selva and Scott, 2001;Buitelaar et al, 2001;Kelly et al, 1998;Martin et al, 2000;Ratzoni et al, 2002;Malone et al, 1999;Buitelaar and Willemsen-Swinkels, 2000;Wudarsky et al, 1999), welldocumented developmental differences in the side effect profiles of medications, and the likelihood that children with psychosis will remain on antipsychotics for years.…”

Section: Introductionmentioning

confidence: 99%

A Pilot Study of Risperidone, Olanzapine, and Haloperidol in Psychotic Youth: A Double-Blind, Randomized, 8-Week Trial

Sikich

Hamer

Bashford

et al. 2003

Neuropsychopharmacol

278

148

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This pilot study was undertaken to estimate the acute antipsychotic effect size and side effect propensity of risperidone and olanzapine in the pediatric population, in comparison to haloperidol, a conventional antipsychotic with established efficacy. Risperidone and olanzapine are widely used as first-line treatments to ameliorate psychotic symptoms in youth, but their abilities to specifically treat children and adolescents presenting due to psychotic symptoms have not been rigorously studied. Subjects, selected because of prominent positive psychotic symptoms, were randomly assigned to double-blind, parallel treatment with risperidone, olanzapine, or haloperidol for 8 weeks. The primary outcome was reduction in the Brief Psychiatric Rating Scale for Children total score from baseline to termination. An exploratory, descriptive analysis was done to compare the three treatments. A total of 50 patients, 8-19 years, participated. All treatments reduced symptoms significantly with p-values (corrected for multiple comparisons) of 0.0018 for each of the atypical agents and 0.012 for haloperidol. In all, 88% of subjects treated with olanzapine, 74% treated with risperidone, and 53% treated with haloperidol met response criteria. The primary side effects observed in all patients were mild to moderate sedation, extrapyramidal symptoms, and weight gain. Risperidone and olanzapine acutely reduced psychotic symptoms in this pediatric sample. Exploratory comparisons indicate the magnitude of the antipsychotic response with these atypical agents is comparable to that observed with haloperidol. However, youth treated with risperidone and olanzapine experienced weight gain and extrapyramidal effects that appear more prevalent and severe than reported in adults.

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“…However, placebocontrolled evidence is limited for adolescents as only 2 of the 4 studies included youth aged 13 years and older, and both of these were small. 6,8 One maintenance study of lowdosage risperidone in youth aged 5 to 17 years supported its efficacy during a 6-month period, but even so, close to 60% of subjects randomized to placebo did not experience recurrence of symptoms. 9 The latter result suggests that even when patients do well with risperidone, tapering the medication is reasonable after several months of stability, especially if adverse effects become problematic.…”

Section: Discussionmentioning

confidence: 99%

Second-Generation Antipsychotics for the Treatment of Disruptive Behaviour Disorders in Children: A Systematic Review

Pringsheim

Gorman

2012

Can J Psychiatry

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Objective: The use of second-generation antipsychotics (SGAs) in youth has increased considerably. Increases are mainly attributable to treatment of disruptive behaviour disorders (DBDs). Our objective was to review the evidence regarding the efficacy of SGAs for DBDs in youth. Method:We performed a systematic review of all randomized controlled trials (RCTs) of SGAs and placebo for the treatment of DBDs in youth, focusing on efficacy data.Results: Eight RCTs in youth with DBDs were included. Five RCTs evaluated the use of risperidone in youth with the combination of subaverage-borderline IQ and disruptive behaviour-aggression. Single RCTs evaluated the use of risperidone for treatment-resistant aggression in attention-deficit hyperactivity disorder and for the treatment of conduct disorder (CD), and a single RCT evaluated the use of quetiapine for adolescent CD. The efficacy results of each of these studies are described. Conclusion:Four placebo-controlled studies support the short-term efficacy of lowdose risperidone in youth with a subaverage IQ. Placebo-controlled evidence is weak or nonexistent for SGAs other than risperidone, and is weak in youth with an average IQ. Multiple factors likely account for the disconnect between this limited evidence base and the frequent use of SGAs for DBDs in clinical practice. These include extrapolation from studies in youth with autism or a subaverage IQ to normally developing youth; ease of SGA titration and the mistaken perception that little monitoring is required; unavailability of psychosocial treatments; limited familiarity with other pharmacological options; clinical and cultural norms; and the influence of the pharmaceutical industry. W W WObjectif : L'utilisation d'antipsychotiques de deuxième génération (ADG) chez les adolescents s'est accrue considérablement. Ces accroissements sont principalement attribuables au traitement des troubles de comportement perturbateur (TCP). Notre objectif était d'examiner les données probantes concernant l'efficacité des ADG pour les TCP chez les adolescents.Méthode : Nous avons effectué une revue systématique de tous les essais randomisés contrôlés (ERC) portant sur les ADG et les placebos pour le traitement des TCP chez les adolescents, en mettant l'accent sur les données d'efficacité.Résultats : Huit ERC sur les adolescents souffrant de TCP ont été inclus. Cinq ERC évaluaient l'utilisation de la rispéridone chez les adolescents présentant une combinaison de QI limite inférieur à la moyenne et de comportement perturbateur-agressif. Des ERC individuels évaluaient l'utilisation de la rispéridone pour l'agressivité réfractaire au traitement dans le trouble de déficit de l'attention avec ou sans hyperactivité et pour le traitement du trouble des conduites (TC), et un seul ERC évaluait l'utilisation de la quétiapine pour le TC adolescent. Les résultats d'efficacité de chacune de ces études sont décrits. Conclusion :Quatre études contrôlées contre placebo soutiennent l'efficacité à court terme de la rispéridone à faible dose chez les...

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A Randomized Controlled Trial of Risperidone in the Treatment of Aggression in Hospitalized Adolescents With Subaverage Cognitive Abilities

Cited by 206 publications

References 0 publications

Risperidone Treatment of Autistic Disorder: Longer-Term Benefits and Blinded Discontinuation After 6 Months

Risperidone Treatment of Autistic Disorder: Longer-Term Benefits and Blinded Discontinuation After 6 Months

A Pilot Study of Risperidone, Olanzapine, and Haloperidol in Psychotic Youth: A Double-Blind, Randomized, 8-Week Trial

Second-Generation Antipsychotics for the Treatment of Disruptive Behaviour Disorders in Children: A Systematic Review

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