Risperidone in the treatment of conduct disorder in preschool children without intellectual disability

Abstract

BackgroundThe DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, 4th edition Textrevision) highlights the especially poor outcomes of early-onset conduct disorder (CD). The strong link between the patient's age at treatment and its efficacy points the importance of early intervention. Risperidone is one of the most commonly studied medications used to treat CD in children and adolescents. The aim of this study is to obtain preliminary data about the efficacy and tolerability of risperidone treatment in otherwise typically developing preschool children with conduct disorder and severe behavioral problems.MethodWe recruited 12 otherwise normally developing preschoolers (ten boys and two girls) with CD for this study. We could not follow up with 4 children at control visits properly; thus, 8 children (six girls, two boys; mean age: 42.4 months) completed the study. We treated the patients with risperidone in an open-label fashion for 8 weeks, starting with a daily dosage of 0.125 mg/day or 0.25 mg/day depending on the patient's weight (<20 kg children: 0.125 mg/day; >20 kg children: 0.25 mg/day). Dosage titration and increments were performed at 2-week interval clinical assessments. The Turgay DSM-IV Based Disruptive Behavior Disorders Child and Adolescent Rating & Screening Scale (T-DSM-IV-S) as well as the Clinical Global Impression Scale (CGI) assessed treatment efficacy; the Extrapyramidal Symptom Rating Scale (ESRS) and laboratory evaluations assessed treatment safety.ResultsThe mean daily dosage of risperidone at the end of 8 weeks was 0.78 mg/day (SD: 0.39) with a maximum dosage of 1.50 mg/day. Based on the CGI global improvement item, we classified all patients as "responders" (very much or much improved). Risperidone was associated with a 78% reduction in the CGI Severity score. We also detected significant improvements on all of the subscales of the T-DSM-IV-S. Tolerability was good, and serious adverse effects were not observed. We detected statistically significant prolactin level increments (p < 0.05), but no clinical symptoms associated with prolactinemia.ConclusionThe results of this study suggest that risperidone may be an effective and well-tolerated atypical antipsychotic for the treatment of CD in otherwise normally developing preschool children. The findings of the study should be interpreted as preliminary data considering its small sample size and open-label methodology.

Risperidone Versus Methylphenidate in Treatment of Preschool Children With Attention-Deficit Hyperactivity Disorder

“…Also our study is in agreement with Ercan's study about risperidone effects for the treatment of normally developing preschool children with diagnosis of Conduct Disorder (CD) co-morbid with ADHD. Result of this open label trial shows that risperidone significantly improved symptoms and subscales of symptoms such as inattention subscale score ( 28 ). Although we used a different questionnaire, in our study there was significant improvement based on Conners scale that measures CD, ODD, ADHD as well as other symptoms.…”

“…Ercan et al measured symptoms with Turgay DSM-IV Based Disruptive Behavior Disorders Child and Adolescent Screening and Rating Scale that assesses inattention, hyperactivity-impulsivity, opposition-defiance and conduct disorder. Indeed both questionnaires assess same symptoms ( 28 ).…”

“…The mean daily dosage of risperidone at the end of 6 weeks was 0.89 ± 0.48 mg/day. The dose was chosen according to the effective dose of risperidone and its side effects from previous studies of risperidone in preschoolers ( 28 - 30 ). Methylphenidate was started at a dose of 2.5 mg per day and gradually (every week) increased based on the therapeutic response and the patient’s tolerance.…”

The prevalance of attention deficit hyperactivity disorder and the frequency of medication use among preschool children in a district children hospital

“…Ülkemizde yapılan bir çalışmada, normal gelişim özellikleri gösteren DEHB+DB tanılı 8 okul öncesi yaşta çocukta risperidon tedavisinin etkinliği 8 haftalık açık çalışmada değerlendirilmiştir. Tüm olgular risperidon tedavisine iyi veya çok iyi yanıt vermiş olup, ciddi bir yan etki gözlenmemiştir (33) . Bu yazın bilgileri ile tutarlı olarak eştanı olmayan ve 1 eştanısı olan hastaların psikososyal yaklaşımların tedavide önerildiği, ancak 2 eştanısı olan hastalarda ilaç tedavisinin başlandığı belirlenmiştir.…”

Prolactin and Schizophrenia, an Evolving Relationship

“…Risperidone is certainly being used in a variety of childhood psychiatric illnesses at young ages. A recent report in a small cohort of patients with conduct disorder (mean age 42 months) treated with risperidone at a mean dosage of 0.78mg/day and a maximum of 1.5mg/day (Ercan et al, 2011) found substantial increase in prolactin from a baseline mean of 5.3 ng/ml to 70 ng/ml at 8 weeks. Six of the eight children who completed the study had hyperprolactinaemia without clinical symptoms, as stated by the authors.…”