Risperidone in Adolescents

Cozza, Stephen J.; Edison, Donna L.

doi:10.1097/00004583-199410000-00023

Cited by 28 publications

(3 citation statements)

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“…Of note, the patients were begun on a relatively aggressive regimen with a dose increase of 0.5 mg/day and a mean final dose ranging from 2 to 6 mg/day of risperidone. Cozza and Edison [35] found significant EPS in two patients aged 15 years after reaching a risperidone dose of 6 mg/day. The EPS lessened after the dose was decreased to 2 mg/day.…”

Section: Tardive Dyskinesia and Extrapyramidal Symptomsmentioning

confidence: 97%

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Tolerability Profile of Atypical Antipsychotics in Children and Adolescents

2001

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Antipsychotics are frequently used in the treatment of a variety of neuropsychiatric conditions in children and adolescents. Atypical antipsychotics have come to the forefront in child psychiatry due largely to their tolerability profiles as well as their efficacy. Potential treatment options include clozapine, risperidone, olanzapine, quetiapine and ziprasidone. A number of studies investigating the use of clozapine have been published in children; however, owing to the frequent monitoring required for agranulocytosis, the use of clozapine may be restricted to patients with treatment-refractory disease. With accumulating data on the development of glucose intolerance in adults receiving clozapine, closer monitoring of bodyweight and fasting blood glucose is imperative. Clozapine also has an increased seizure risk, therefore a baseline electroencephalogram should be performed, as well as continued vigilance for this adverse effect. Risperidone is an atypical antipsychotic that is generally well tolerated and numerous studies have been published investigating this drug in children. Unlike clozapine, its receptor interaction profile lends itself toward increased risk of extrapyramidal symptoms (EPS) and hyperprolactinaemia. Bodyweight gain is a common adverse effect, although somewhat less than that reported with olanzapine. Baseline liver function studies prior to initiation of this medication are recommended. Risperidone-induced mania has been reported in adults and, therefore, increased caution should be used when deciding to treat children and adolescents with risperidone, particularly in those with a predisposition toward mania. Olanzapine, like risperidone, has also been associated with onset of mania in adults. Olanzapine has a receptor profile that results in significant risk for bodyweight gain and sedation. Furthermore, this drug has been linked to the development of glucose intolerance; thus, it is important to monitor bodyweight and fasting blood glucose on a frequent basis. Less information is known about quetiapine in children and adolescents. Reports about its efficacy and tolerability vary. Quetiapine appears to have increased risk for sedation and bodyweight gain, albeit less than that of olanzapine. The compound appears to be less likely to induce EPS. Finally, ziprasidone has recently been approved for use in the adult population. This compound, in terms of its receptor profile, has more in common with risperidone. This suggests a potential for increased risk of EPS and hyperprolactinaemia. It also has an increased risk of QTc prolongation; thus, a baseline electrocardiogram is suggested, particularly in those patients with a history of cardiovascular illness. Lack of evidence for bodyweight gain with ziprasidone is a considerable advantage.

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Section: Tardive Dyskinesia and Extrapyramidal Symptomsmentioning

confidence: 97%

“…[27,[34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52] In nonblind studies, risperidone has effectively targeted core and related symptoms of PDDs. In studies of 40 children and adolescents (age range 4.5 to 18 years) with PDD and comorbid mental retardation, mean doses ranged from 0.75 to 2.7 mg/day.…”

Section: Other Indicationsmentioning

confidence: 99%

Tolerability Profile of Atypical Antipsychotics in Children and Adolescents

2001

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“…Previous case reports that employed a gradual dosing strategy also reported a low incidence of EPS (Simeon et al 1995, Quintana andKeshavan 1995), whereas case reports of rapid titration reported a high incidence of EPS (Cozza andEdison 1994, Mandoki 1995). Defining optimal dose-titration strategies that can minimize the risk of EPS while maximizing the therapeutic effects of risperidone therapy in psychotic youngsters should be a goal for further studies.…”

Section: Discussionmentioning

confidence: 95%

Risperidone in the Treatment of Children and Adolescents with Schizophrenia: A Retrospective Study

Grcevich¹,

Findling²,

Rowane³

et al. 1996

Journal of Child and Adolescent Psychopharmacology

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Risperidone is a newly available atypical antipsychotic agent that has been reported to be associated with fewer extrapyramidal side effects (EPS) than conventional neuroleptics in adults with schizophrenia. This study assessed the safety and efficacy of risperidone in 16 children and adolescents (aged 9-20 years, mean 14.9 years) who were clinically diagnosed with psychotic disorders: 13 patients met DSM-III-R criteria for schizophrenia, 2 met criteria for schizoaffective disorder, and 1 had schizophreniform disorder. Eleven of the 16 patients had previous unsuccessful neuroleptic trials. Patient charts were reviewed by the patients' child and adolescent psychiatrist for diagnoses, clinical changes, and adverse events. Clinical response was assessed retrospectively using the Brief Psychiatric Rating Scale (BPRS) and the Clinical Global Impression (CGI) scale. With the risperidone dose titrated gradually, an optimal clinical response was found at a mean daily risperidone dose of 5.93 mg (range 2-10 mg). All but one of the 16 patients had an adequate clinical response to risperidone therapy. Statistically significant improvements were found in the CGI (p < 0.0001), the BPRS Total Score (p < 0.0001), and the BPRS Negative Symptom Score (p < 0.001). In general, only mild drug-induced side effects were experienced, with 5 patients developing mild sedation and 3 developing EPS. Risperidone appeared to be safe and effective in ameliorating symptoms of schizophrenia in this age group. It is speculated that the gradual titration of risperidone was crucial in achieving a relatively low rate of EPS.

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