Risperidone conduct disorders

A child with attention-deficit hyperactivity disorder [ADHD] and conduct disorder is treated with 45 mg/d of methylphenidate and 2 mg/d of risperidone. A new diagnosis of complex partial seizures is made and the child is started on carbamazepine. About 10 days after the initiation of carbamazepine, the child develops withdrawal dyskinesias of mouth and tongue. After discontinuation of carbamazepine, the movements last for 1 week. 

Risperidone Benzisoxazole 0.25-10 High 2 Bipolar disorder Conduct disorder PDD Psychotic disorders Tic disorders Frazier et ah, 1999 Findling et ah, 2000a McDougle et ah, 1997 Armenteros et ah, 1997 Lombroso et ah, 1995... 

Findling, R.T., McNamara, N.K., Branicky, T.A., Schluchter, M.D., Temon, E., and Blumer, J.T. (2000a) A double-blind pilot study of risperidone in conduct disorder. / Am Acad Child Adolesc Psychiatry 39 509-516. 

The main indications for atypical antipsychotics are the acute and maintenance treatment of schizophrenic disorders, with an emphasis on the treatment of refractory and chronic disorders. However, because of the lower risk of EPS and in particular of tardive dyskinesia, there is a tendency toward a wider range of indications for some of the atypical neuroleptics. Favorable effects in drug-induced psychoses have been demonstrated for olanzapine. Clozapine seems effective in the treatment and relapse prevention of manic episodes and bipolar disorders, and risperidone has been shown to have good efficacy in conduct disorders and in the pervasive developmental disorders. 

Recently, Janssen Pharmaceutica launched several studies of risperidone in children with borderline IQ or MR and a diagnosis of disruptive behavior disorder (usually oppositional defiant disorder or conduct disorder). To be admissible into the study, subjects needed to be 5 to 12 years old, inclusive, and score above 24 on the Conduct Problem subscale of the Nisonger Child Behavior Rating Form (NCBRF). One 6-week acute trial (n = 118) was conducted in the United States (Aman et al., in press), whereas the other n = 110) was based in Canada (Snyder et al., in press). The findings of the two studies were virtually identical, with... 

Snyder, R., Turgay, A., Aman, M.G., Binder, C., Fisman, S., Carroll, A., and The Risperidone Conduct Study Group. (In press) Effects of risperidone on conduct and disruptive behavior disorders in children with subaverage IQs. / Am Acad Child Adoles Psychiatry. 

Aman, M.G., Findling, R.L., Derivan, A., and Merriman, U. (2000) Risperidone versus placebo for severe conduct disorder in children with mental retardation [NCDEU abstract]. / Child Adolesc Psychopharmacol 10 253. 

In another study, 118 children with IQs ranging from 35 to 84 who demonstrated conduct disorder were randomized to risperidone (at a mean dose of 1.23 mg/day) versus placebo in a double-blind design (96). In comparison with placebo, risperidone produced a statistically significant reduction in insecure/anxious behavior, hyperactivity, self-injurious/stereotyped behavior, irritability, and aggressive/destructive behavior, as well as an increase in adaptive social behavior. The latter is important because it shows that the changes are not due to sedation, although more somnolence was apparent with risperidone. 

Findling RL, McNamara NK, Branicky LA, et al. Risperidone in children with conduct disorder. Presented at the 37th Annual Meeting of the American College of Neuropsychopharmacology, Las Croabas, Puerto Rico, December 14-18, 1998. 

In 21 Turkish children and adolescents with conduct disorder (17 boys and 4 girls mean age 11 years), the mean dose of risperidone at the 8-week endpoint was 1.27 mg/day (21). There were significant improvements... 

Ercan ES, Kutlu A, Cikoglu S, Veznedaroglu B, Erermis S, Varan A. Risperidone in children and adolescents with conduct disorder a single-center, open-label study. Curr Ther Res 2003 64 55-64. 

Findling RL, McNamara NK, Branicky LA, Schluchter MD, Lemon E, Blumer JL. A double-blind pilot study of risperidone in the treatment of conduct disorder. J Am Acad Child Adolesc Psychiatry 2000 39(4) 509-16. 

Conventional antipsychotics improve symptoms of hyperactivity and impulsivity, but may have negative effects on learning and cognitive functioning as well as extrapyramidal side effects (e.g., dystonia and tardive dyskinesia) that limit their usefulness. The atypical antipsychotics risperidone, olanzapine, quetiapine, and ziprasidone have been used to control severe aggression in refractory cases of ADHD, particularly if conduct disorder or bipolar disorder coexists. More studies are needed to clarify their place in therapy. ... 

In a retrospective study of male delinquents, mean age 16 years, with childhood onset and persistent conduct disorder treated either with psychosocial treatment and risperidone (mean dose 2.5 mg/day n = 60) or cognitive-behavioral treatment alone n = 69), the most common adverse events in the patients taking risperidone were somnolence (26%), weight gain (18%), increased appetite (17%), and constipation (14%) mean body weight increased by 6.8 kg during a mean time of 9 months [119. ... 

Low dose risperidone is occasionally used for short-term aggression management in conduct disorder or autism... 

On the basis of these results and other clinical, pre-clinical and safety data, the RUPP Autism Network chose risperidone as the first drug to study in children and adolescents with autistic disorder (McDougle et al., 2000b). When completed, this investigation will be the largest drug study conducted to date in autistic disorder, with an anticipated sample size of 101 children and adolescents. 

Remington et al. (2006) conducted a similar PET study of the long-acting injectable form of risperidone at doses of 25, 50, or 75 mg every 2 weeks. After reaching stabilization, nine patients with a diagnosis of schizophrenia or schizoaffective disorder were scanned twice, 3 days postinjection and 5 days before the next injection. According to Remington et al. (2006), all three doses of injectable risperidone showed peak D(2) occupancy levels above the 65% threshold associated with optimal clinical response the 75-mg dose approximated the 80% threshold linked to increased risk of extrapyramidal reactions. Clearly, it is all in the dose all of the atypicals are potent dopamine blockers. 

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