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Risperidone in the management of agitation and aggression associated with psychiatric disorders

Published online by Cambridge University Press:  16 April 2020

Peter Paul De Deyn  and
Jan Buitelaar
Peter Paul De Deyn*
Affiliation:
Department of Neurology, Middelheim Hospital and Laboratory of Neurochemistry and Behavior, Department of Biomedical Sciences, Born Bunge Foundation, University of Antwerp (UA), Universiteitsplein 1, 2610Antwerp (Wilrijk), Belgium
Jan Buitelaar
Affiliation:
Department of Psychiatry and Academic Center for Child and Adolescent Psychiatry, University Medical Center, St Radboud, Nijmegen, The Netherlands
*
*Corresponding author. E-mail address:dedeyn@skynet.be (P.P. De Deyn).
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Abstract

Objective

This review provides an overview of the prevalence and treatment of agitation and aggression, and focuses on the use of risperidone to treat these symptoms in patients from different age groups.

Methods

MEDLINE® and EMBASE® databases were used to identify controlled studies of risperidone in the treatment of disruptive behavior disorders and pervasive developmental disorders in pediatric patients, acute agitation or aggression in adults, and psychological and behavioral symptoms of dementia in the elderly. Additionally, key open-label, long-term trials assessing the efficacy and safety of risperidone were considered.

Results

The results of the 19 double-blind studies identified showed that risperidone is effective in treating agitation and aggression in the different populations, regardless of age. The safety and tolerability of risperidone appear to be good overall but certain safety issues, such as a higher risk of cerebrovascular adverse events in the elderly with dementia, were highlighted.

Conclusions

Risperidone is useful for treating aggression and agitation associated with various psychiatric disorders in patients from different age groups.

Keywords

RisperidoneAgitationAggressionPediatricGeriatricAdult
Type
Review
Information
European Psychiatry , Volume 21 , Issue 1 , January 2006 , pp. 21 - 28
Copyright
Copyright © Elsevier SAS 2006

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References

Swann, ACNeuroreceptor mechanisms of aggression and its treatment. J. Clin. Psychiatry 2003;64(Suppl 4):26–35.Google ScholarPubMed
American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-IV. 4th ed., text revision Washington, DC: American Psychiatric Publishing Inc.; 2000.Google Scholar
Angold, AErkanli, AFarmer, EMFairbank, JABurns, BJKeeler, Get al.Psychiatric disorder, impairment, and service use in rural African American and white youth. Arch. Gen. Psychiatry 2002;59:893–901.CrossRefGoogle ScholarPubMed
Emerson, EPrevalence of psychiatric disorders in children and adolescents with and without intellectual disability. J. Intellect. Disabil. Res. 2003;47(Pt 1):51–58.CrossRefGoogle ScholarPubMed
Barlow, KGrenyer, BIlkiw-Lavalle, OPrevalence and precipitants of aggression in psychiatric inpatient units. Aust. N. Z. J. Psychiatry 2000;34:967–974.CrossRefGoogle ScholarPubMed
Grassi, LPeron, LMarangoni, CZanchi, PVanni, ACharacteristics of violent behaviour in acute psychiatric in-patients: a 5-year Italian study. Acta Psychiatr. Scand. 2001;104:273–279.CrossRefGoogle ScholarPubMed
Binder, RLMcNiel, DEEffects of diagnosis and context on dangerousness. Am. J. Psychiatry 1988;145(6):728–732.Google Scholar
Swanson, JWMental disorder, substance abuse and community violence: an epidemiological approach. In: Monahan, JSteadman, HJ, editors. In violence and mental disorder: developments in risk assessment Chicago: The University of Chicago Press; 1994. p. 101–136..Google Scholar
Lyketsos, CGSteinberg, MTschanz, JTNorton, MCSteffens, DCBreitner, JCMental and behavioral disturbances in dementia: findings from the Cache County Study on Memory in Aging. Am. J. Psychiatry 2000;157:708–714.CrossRefGoogle Scholar
Lyketsos, CGLopez, OJones, BFitzpatrick, ALBreitner, JDeKosky, SPrevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: results from the cardiovascular health study. JAMA 2002;228:1475–1483.CrossRefGoogle Scholar
Chan, DCKasper, JDBlack, BSRabins, PVPrevalence and correlates of behavioral and psychiatric symptoms in community-dwelling elders with dementia or mild cognitive impairment: the Memory and Medical Care Study. Int. J. Geriatr. Psychiatry 2003;18:174–182.CrossRefGoogle ScholarPubMed
Margallo-Lana, MSwann, AO’Brien, JFairbairn, AReichelt, KPotkins, Det al.Prevalence and pharmacological management of behavioural and psychological symptoms amongst dementia sufferers living in care environments. Int. J. Geriatr. Psychiatry 2001;16:39–44.3.0.CO;2-F>CrossRefGoogle ScholarPubMed
Jeste, DVFinkel, SIPsychosis of Alzheimer’s disease and related dementias. Diagnostic criteria for a distinct syndrome. Am. J. Geriatr. Psychiatry 2000;8:29–34.CrossRefGoogle ScholarPubMed
Renouf, AGKovacs, MMukerji, PRelationship of depressive, conduct, and comorbid disorders and social functioning in childhood. J. Am. Acad. Child Adolesc. Psychiatry 1997;36:998–1004.CrossRefGoogle Scholar
Schaeffer, CMPetras, HIalongo, NPoduska, JKellam, SModeling growth in boys’ aggressive behavior across elementary school: links to later criminal involvement, conduct disorder, and antisocial personality disorder. Dev. Psychol. 2003;39:1020–1035.CrossRefGoogle ScholarPubMed
Loeber, RBurke, JDLahey, BBWinters, AZera, MOppositional defiant and conduct disorder: a review of the past 10 years, part I. J. Am. Acad. Child Adolesc. Psychiatry 2000;39:1468–1484.CrossRefGoogle ScholarPubMed
Hechtman, LOfford, DRLong-term outcome of disruptive disorders. Child Adolesc. Psychiatry Clin. North America 1994;3:379–403.CrossRefGoogle Scholar
Dhossche, DMGhani, SOWho brings patients to the psychiatric emergency room? Psychosocial and psychiatric correlates. Gen. Hosp. Psychiatry 1998;20:235–240.CrossRefGoogle ScholarPubMed
Coen, RFSwanwick, GRO’Boyle, CACoakley, DBehaviour disturbance and other predictors of carer burden in Alzheimer’s disease. Int. J. Geriatr. Psychiatry 1997;12:331–336.3.0.CO;2-J>CrossRefGoogle ScholarPubMed
Fernandes, CMBouthillette, FRaboud, JMBullock, LMoore, CFChristenson, JMet al.Violence in the emergency department: a survey of health care workers. CMAJ 1999;161:1245–1248.Google ScholarPubMed
Currier, GWAtypical antipsychotic medications in the psychiatric emergency service. J. Clin. Psychiatry 2000;61(Suppl 14):21–26.Google ScholarPubMed
Victoroff, JMack, WJNielson, KAPsychiatric complications of dementia: impact on caregivers. Dement. Geriatr. Cogn. Disord. 1998;9:50–55.CrossRefGoogle ScholarPubMed
Yaffe, KFox, PNewcomer, RSands, LLinquist, KDane, Ket al.Patient and caregiver characteristics and nursing home placement in patients with dementia. JAMA 2002;287:2090–2097.CrossRefGoogle ScholarPubMed
Marx, MSCohen-Mansfield, JWerner, PAgitation and falls in institutionalized elderly persons. J. Appl. Gerontol. 1990;9:106–117.CrossRefGoogle ScholarPubMed
Leger, JMMoulias, RRobert, PVellas, BChapuy, PHMonfort, JCet al.Agitation and aggressiveness among the elderly population living in nursing or retirement homes in France. Int. Psychogeriatr. 2002;14:405–416.CrossRefGoogle ScholarPubMed
Pappadopulos, EMacIntyre, JCCrismon, MLFindling, RLMalone, RPDerivan, Aet al.Treatment recommendations for the use of antipsychotics for aggressive youth (TRAAY). Part II. J. Am. Acad. Child Adolesc. Psychiatry 2nd 2003;42:145–161.CrossRefGoogle ScholarPubMed
Rappaport, NThomas, CRecent research findings on aggressive and violent behavior in youth: implications for clinical assessment and intervention. J. Adolesc. Health 2004;35(4):260–277.CrossRefGoogle ScholarPubMed
Hughes, DHKleespies, PMTreating aggression in the psychiatric emergency service. J. Clin. Psychiatry 2003;64(Suppl 4):10–15.Google ScholarPubMed
Yildiz, ASachs, GSTurgay, APharmacological management of agitation in emergency settings. Emerg. Med. J. 2003;20:339–346.CrossRefGoogle ScholarPubMed
Findling, RLMcNamara, NKBranicky, LASchluchter, MDLemon, EBlumer, JLA double-blind pilot study of risperidone in the treatment of conduct disorder. J. Am. Acad. Child Adolesc. Psychiatry 2000;39:509–516.CrossRefGoogle ScholarPubMed
Buitelaar, JKvan der Gaag, RJCohen-Kettenis, PMelman, CTA randomized controlled trial of risperidone in the treatment of aggression in hospitalized adolescents with subaverage cognitive abilities. J. Clin. Psychiatry 2001;62:239–248.CrossRefGoogle ScholarPubMed
Van Bellinghen, MDe Troch, CRisperidone in the treatment of behavioral disturbances in children and adolescents with borderline intellectual functioning: a double-blind, placebo-controlled pilot trial. J. Child Adolesc. Psychopharmacol. 2001;11:5–13.CrossRefGoogle ScholarPubMed
Snyder, RTurgay, AAman, MBinder, CFisman, SCarroll, ARisperidone Conduct Study Group. Effects of risperidone on conduct and disruptive behavior disorders in children with subaverage IQs. J. Am. Acad. Child Adolesc. Psychiatry 2002;41:1026–1036.CrossRefGoogle Scholar
Aman, MGDe Smedt, GDerivan, ALyons, BFindling, RLRisperidone Disruptive Behavior Study Group. Double-blind, placebo-controlled study of risperidone for the treatment of disruptive behaviors in children with subaverage intelligence. Am. J. Psychiatry 2002;159:1337–1346.CrossRefGoogle Scholar
McCracken, JTMcGough, JShah, BCronin, PHong, DAman, MGet al.Research Units on Pediatric Psychopharmacology Autism Network. Risperidone in children with autism and serious behavioral problems. N. Engl. J. Med. 2002;347:314–321.CrossRefGoogle ScholarPubMed
Shea, STurgay, ACarroll, ASchulz, MOrlik, HSmith, Iet al.Risperidone in the treatment of disruptive behavioral symptoms in children with autistic and other pervasive developmental disorders. Pediatrics 2004;114:e634–e641.CrossRefGoogle ScholarPubMed
Arnold, LEVitiello, BMcDougle, CScahill, LShah, BGonzalez, NMet al.Parent-defined target symptoms respond to risperidone in RUPP autism study: customer approach to clinical trials. J. Am. Acad. Child Adolesc. Psychiatry 2003;42:1443–1450.CrossRefGoogle ScholarPubMed
Turgay, ABinder, CSnyder, RFisman, SLong-term safety and efficacy of risperidone for the treatment of disruptive behavior disorders in children with subaverage IQs. Pediatrics 2002;110:e34.CrossRefGoogle ScholarPubMed
Findling, RLAman, MGEerdekens, MDerivan, ALyons, BRisperidone Disruptive Behavior Study Group. Long-term, open-label study of risperidone in children with severe disruptive behaviors and below-average IQ. Am. J. Psychiatry 2004;161:677–684.CrossRefGoogle Scholar
Masi, GCosenza, AMucci, MProlactin levels in young children with pervasive developmental disorders during risperidone treatment. J. Child Adolesc. Psychopharmacol. 2001;11(4):389–394.CrossRefGoogle ScholarPubMed
Gagliano, AGermano, EPustorino, GImpallomeni, CD’Arrigo, CCalamoneri, Fet al.Risperidone treatment of children with autistic disorder: effectiveness, tolerability, and pharmacokinetic implications. J. Child Adolesc. Psychopharmacol. 2004;14(1):39–47.CrossRefGoogle ScholarPubMed
Saito, ECorrell, CUGallelli, KMcMeniman, MParikh, UHMalhotra, AKet al.A prospective study of hyperprolactinemia in children and adolescents treated with atypical antipsychotic agents. J. Child Adolesc. Psychopharmacol. 2004;14(3):350–358.CrossRefGoogle ScholarPubMed
Dunbar, FKusumakar, VDaneman, DSchulz, MGrowth and sexual maturation during long-term treatment with risperidone. Am. J. Psychiatry 2004;161:918–920.CrossRefGoogle ScholarPubMed
Reyes, M.Buitelaar, J.Augustyns, I.Eerdekens, M.(2004) Relapse prevention of disruptive behavior disorders in children and adolescents: a 6-month trial of risperidone versus placebo. Poster presented at the 16th World Congress of the International Association of Child and Adolescent Psychiatry and Allied Professions (IACAPAP), August 22–26 2004, Berlin, Germany.Google Scholar
Aman, MGBinder, CTurgay, ARisperidone effects in the presence/absence of psychostimulant medicine in children with ADHD, other disruptive behavior disorders, and subaverage IQ. J. Child Adolesc. Psychopharmacol. 2004;14:243–254.CrossRefGoogle ScholarPubMed
Blin, OAzorin, JMBouhours, PAntipsychotic and anxiolytic properties of risperidone, haloperidol, and methotrimeprazine in schizophrenic patients. J. Clin. Psychopharmacol. 1996;16:38–44.CrossRefGoogle ScholarPubMed
Segal, JBerk, MBrook, SRisperidone compared with both lithium and haloperidol in mania: a double-blind randomized controlled trial. Clin. Neuropharmacol. 1998;21:176–180.Google ScholarPubMed
McDougle, CJHolmes, JPCarlson, DCPelton, GHCohen, DJPrice, LHA double-blind, placebo-controlled study of risperidone in adults with autistic disorder and other pervasive developmental disorders. Arch. Gen. Psychiatry 1998;55:633–641.CrossRefGoogle ScholarPubMed
Sachs, GSGrossman, FGhaemi, SNOkamoto, ABowden, CLCombination of a mood stabilizer with risperidone or haloperidol for treatment of acute mania: a double-blind, placebo-controlled comparison of efficacy and safety. Am. J. Psychiatry 2002;159:1146–1154.CrossRefGoogle ScholarPubMed
Yatham, LNGrossman, FAugustyns, IVieta, ERavindran, AMood stabilisers plus risperidone or placebo in the treatment of acute mania. International, double-blind, randomized controlled trial. Br. J. Psychiatry 2003;182:141–147.CrossRefGoogle ScholarPubMed
Currier, GWChou, JCFeifel, DBossie, CATurkoz, IMahmoud, RAet al.Acute treatment of psychotic agitation: a randomized comparison of oral treatment with risperidone and lorazepam versus intramuscular treatment with haloperidol and lorazepam. J. Clin. Psychiatry 2004;65:386–394.CrossRefGoogle ScholarPubMed
Czobor, PVolavka, JMeibach, RCEffect of risperidone on hostility in schizophrenia. J. Clin. Psychopharmacol. 1995;15:243–249.CrossRefGoogle Scholar
Citrome, LVolavka, JCzobor, PSheitman, BLindenmayer, J.-P.McEvoy, Jet al.Effects of clozapine, olanzapine, risperidone, and haloperidol on hostility among patients with schizophrenia. Psychiatr. Serv. 2001;52(11):1510–1514.CrossRefGoogle ScholarPubMed
Volavka, JCzobor, PNolan, KSheitman, BLindenmayer, J.-P.Citrome, Let al.Overt aggression and psychotic symptoms in patients with schizophrenia treated with clozapine, olanzapine, risperidone, or haloperidol. J. Clin. Psychopharmacol. 2004;24:225–228.CrossRefGoogle ScholarPubMed
Buckley, PFIbrahim, ZYSinger, BOrr, BDonenwirth, KBrat, PSAggression and schizophrenia: efficacy of risperidone. J. Am. Acad. Psychiatry Law 1997;25(2):173–181.Google ScholarPubMed
Beck, NCGreenfield, SRGotham, HMenditto, AAStuve, PHemme, CARisperidone in the management of violent, treatment-resistant schizophrenics hospitalized in a maximum security forensic facility. J. Am. Acad. Psychiatry Law 1997;25(4):461–468.Google Scholar
Currier, GWSimpson, GMRisperidone liquid concentrate and oral lorazepam versus intramuscular haloperidol and intramuscular lorazepam for treatment of psychotic agitation. J. Clin. Psychiatry 2001;62:153–157.CrossRefGoogle ScholarPubMed
Hirose, SEffective treatment of aggression and impulsivity in antisocial personality disorder with risperidone. Psychiatry Clin. Neurosci. 2001;55:161–162.CrossRefGoogle ScholarPubMed
Rocca, PMarchiaro, LCocuzza, EBogetto, FTreatment of borderline personality disorder with risperidone. J. Clin. Psychiatry 2002;63:241–244.CrossRefGoogle ScholarPubMed
Risperidone. package insert. 2005; http://www.risperdal.com/active/janus/en_US/assets/common/company/pi/risperdal.pdf.Google Scholar
Meaney, AMSmith, SHowes, ODO’Brien, MMurray, RMO’Keane, VEffects of long-term prolactin-raising antipsychotic medication on bone mineral density in patients with schizophrenia. Br. J. Psychiatry 2004;185:503–508.CrossRefGoogle Scholar
De Deyn, PPRabheru, KRasmussen, ABocksberger, JPDantzenberg, PLEriksson, Set al.A randomized trial of risperidone, placebo, and haloperidol for behavioral symptoms of dementia. Neurology 1999;53:946–955.CrossRefGoogle ScholarPubMed
Katz, IRJeste, DVMintzer, JEClyde, CNapolitano, JBrecher, MComparison of risperidone and placebo for psychosis and behavioral disturbances associated with dementia: a randomized, double-blind trial. Risperidone Study Group. J. Clin. Psychiatry 1999;60:107–115.CrossRefGoogle ScholarPubMed
Chan, WCLam, LCChoy, CNLeung, VPLi, SWChiu, HFA double-blind randomised comparison of risperidone and haloperidol in the treatment of behavioural and psychological symptoms in Chinese dementia patients. Int. J. Geriatr. Psychiatry 2001;16:1156–1162.CrossRefGoogle ScholarPubMed
Brodaty, HAmes, DSnowdon, JWoodward, MKirwan, JClarnette, Ret al.A randomized placebo-controlled trial of risperidone for the treatment of aggression, agitation, and psychosis of dementia. J. Clin. Psychiatry 2003;64:134–143.CrossRefGoogle Scholar
Fontaine, CSHynan, LSKoch, KMartin-Cook, KSvetlik, DWeiner, MFA double-blind comparison of olanzapine versus risperidone in the acute treatment of dementia-related behavioral disturbances in extended care facilities. J. Clin. Psychiatry 2003;64:726–730.CrossRefGoogle ScholarPubMed
Suh, GHSon, HGJu, YSJcho, KHYeon, BKShin, YMet al.A randomized, double-blind, crossover comparison of risperidone and haloperidol in Korean dementia patients with behavioral disturbances. Am. J. Geriatr. Psychiatry 2004;12:509–516.CrossRefGoogle ScholarPubMed
De Deyn, PPKatz, IRControl of aggression and agitation in patients with dementia: efficacy and safety of risperidone. Int. J. Geriatr. Psychiatry 2000;15(Suppl 1):S14–S22.3.0.CO;2-#>CrossRefGoogle ScholarPubMed
Jeste, DVOkamoto, ANapolitano, JKane, JMMartinez, RALow incidence of persistent tardive dyskinesia in elderly patients with dementia treated with risperidone. Am. J. Psychiatry 2000;157:1150–1155.CrossRefGoogle ScholarPubMed
Feldman, PDHay, LKDeberdt, WKennedy, JSHutchins, DSHay, DPet al.Retrospective cohort study of diabetes mellitus and antipsychotic treatment in a geriatric population in the United States. J. Am. Med. Dir. Assoc. 2004;5:38–46.CrossRefGoogle Scholar
US Food and Drug Administration. Public Health Advisory. Deaths with antipsychotics in elderly patients with behavioral disturbances. April 11, 2005. http://www.fda.gov/cder/drug/advisory/antipsychotics.htm Accessed August 15.Google Scholar
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