Risperidone Added to Psychostimulant in Children with Severe Aggression and Attention-Deficit/Hyperactivity Disorder: Lack of Effect on Attention and Short-Term Memory

Abstract

Objective: Professionals have periodically expressed concern that atypical antipsychotics may cause cognitive blunting in treated patients. In this study, we report data from a double-blind, randomized, controlled study of stimulant plus placebo versus combined stimulant and risperidone to evaluate the effects of the atypical antipsychotic on attention and short-term memory. Methods: A total of 165 (n = 83 combined treatment; n = 82 stimulant plus placebo) children with attention-deficit/hyperactivity disorder and severe physical aggression, aged 6-12 years, were evaluated with Conners' Continuous Performance Test (CPT-II) and the Wechsler Intelligence Scale for Children-III (WISC) Digit Span subscale at baseline, after 3 weeks of stimulant-only treatment, and after six additional weeks of randomized treatment (stimulant+placebo vs. stimulant+risperidone). Results: At 3 weeks, improvement on CPT-II performance (Commissions and Reaction Time Standard Error; p < 0.001) and on Digit Span memory performance ( p < 0.006) was noted for the full sample. At study week 9, no difference in CPT-II or Digit Span performance was observed between the randomized groups ( ps = 0.41 to 0.83). Conclusions: Similar to other studies, we found no deleterious effects on attention and short-term memory associated with short-term use of risperidone. NCT00796302.

Antipsychotics in the Management of Disruptive Behavior Disorders in Children and Adolescents: An Update and Critical Review

“…Given the concerns related to cognitive blunting and dulling with the use of older antipsychotics in children [44], a single clinical trial examined the effects of adjunctive risperidone (mean dose 1.7 mg/day), compared to placebo, on two measures of cognition -the Continuous Performance Test-II (CPT-II) and the Digit Span subscale of the Weschler Intelligence Scale for children. Over a period of six weeks, no significant differences were identified between the two groups in terms of cognitive performance on either measure [35]. However, all participants in this study were receiving concurrent methylphenidate, as well as psychosocial intervention in the form of parent training.…”

“…Given that younger age is a risk factor for clozapine-induced neutropenia, this drug is best avoided in this population, and careful monitoring of white cell counts would also be warranted if risperidone is being prescribed. The evidence from these short-to medium-term trials suggests that the risk of extrapyramidal adverse effects or cognitive impairment is low or minimal [35][36][37][38]. However, it must be borne in mind that these results were obtained in the context of low-dose antipsychotic use in carefully selected and monitored study populations; it is possible that extrapyramidal or cognitive adverse effects could appear when antipsychotics are prescribed for DBDs at higher doses or longer durations [59].…”

“…The review process is depicted graphically in Figure 1. A total of six studies fulfilled these criteria, and are summarized in chronological order in Table 3 [35][36][37][38][39][40]. The detailed characteristics of these studies are described below.…”

The effects of amphetamine on working memory and locomotor activity in adult rats administered risperidone early in life

“…Antipsychotic drugs are used for a host of disorders in children; mainly to manage behavioral symptoms such as irritability and aggressiveness [2,3]. Clinical studies have also considered the relatively short-term effects of antipsychotic drugs alone or in combination with other drugs, on cognition in such children, with generally mixed findings of no effect or slight improvements in attention and working memory [40,41]. However, clinical investigation of the effects of developmental risperidone administration on cognition is problematic since it is difficult to disentangle the effects of drug from disorder or other circumstances on measures such as working memory.…”

Polypharmacy in the Management of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents: A Review and Update

“…COMB treatment was associated with reductions in anxiety and psychotic spectrum symptoms (Arnold et al 2015). Finally, analysis of cognitive measures found initial significant improvement in digit span memory for COMB at before randomization but not at study endpoint, leading authors to conclude that risperidone lacked deleterious effects on attention and short-term memory (Farmer et al 2017).…”