Autism: parent training helps improve behaviour and reduce drugs

Children with autism often have behaviour problems such as tantrums, aggression and self-injury as well. An antipsychotic drug called risperidone is sometimes used to reduce this behaviour but the problems return once the medication is stopped and the drug can cause children to put on weight leading to health problems and obesity. Researchers from the National Institute of Mental Health in the U.S. have been studying the effectiveness of adding a training programme to help parents manage their children's disruptive behaviour on top of the drug therapy (combination therapy). They split 124 children aged between 4 and 13 into two groups. Over the 24 weeks of the study one group received just risperidone while the other group received risperidone and, for their parents, the training programme. Both groups improved but the combination therapy group improved more showing less irritability, tantrums and impulsiveness. They also took less risperidone although they still put on as much weight as the drugs-only group.

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Risperidone: longer-acting for harder cases

A depot injection is given via a long-lasting injection and aims to promote compliance in people with particularly severe mental illness, thereby enhancing relapse prevention. Risperidone is the first second-generation antipsychotic to be available in a depot format. The effects of this form of the drug have been extensively studied in trials prior to its introduction but the kinds of people who might take it have not. A Dutch study, using dispensing data from 53 community pharmacies in the north-east of the Netherlands looked to see what kind of chronic antipsychotic users switched to long-acting Risperidone. They found that the predictors for switching from an oral to a depot form of drugs were: being a man, a previous use of depot antipsychotics, recent anticholinergic drug use, and a gap in 'antipsychotic dispensation history,' i.e. a patchy history of drug-taking. Predictors of switching to depot Risperidone from a depot first-generation antipsychotic were previous use of a depot antipsychotic and consulting a specialist. The researchers concluded that compared with oral antipsychotics service users receiving a depot injection were likely to be less compliant and to suffer from worse side effects. People receiving depot risperidone as opposed to a depot first-generation antipsychotic tended to be more severely ill. The researchers concluded that the long-lasting risperidone was being used for the most severely-ill people; something that will need to be borne in mind when assessing its effectiveness.

Vehof, Jelle ... [et al] - Predictors for starting depot administration of risperidone in chronic users of antipsychotics Journal of Clinical Psychopharmacology December 2008, 28(6), 625-630

Antipsychotics for young people

Atypical, or second-generation antipsychotics are considered to be the standard treatment for children and adolescents with early-onset schizophrenia and schizoaffective disorder. However, the superiority of atypical antipsychotics over older, first-generation antipsychotics has not been demonstrated. Researchers from a number of different U.S. universities randomly assigned 116 children to receive either the second-generation antipsychotics olanzapine or risperidone or a first-generation drug molindone. Molindone had a better response rate (50%) than olanzapine (34%) or risperidone (46%) although this difference was not statistically significant, and there was no difference between the drugs in terms of symptom reduction. Olanzapine and risperidone showed the greatest risk of weight gain and other metabolic side effects while molindone led to more of the participants saying they suffered from akathisia, an unpleasant feeling of fidgetiness and an inability to sit still.

Sikich, Linmarie ... [et al] - Double-blind comparison of first- and second-generation antipsychotics in early-onset schizophrenia and schizoaffective disorder: findings from the Treatment of Early-Onset Schizophrenia Spectrum Disorders (TEOSS) Study American Journal of Psychiatry November 2008, 165(11), 1420-1431

Risperidone for depression in older adults

Mood disorders are a significant health care issue in the elderly and are associated with suffering, functional decline, compromised quality of life, care-giver burden and increased rates of suicide and service utilization. Persistent depression worsens the outcome of other illnesses and increases non-suicide mortality. Only a third of depressed older adults achieve remission with another 20% showing a partial improvement. Adding an atypical antipsychotic to an antidepressant is one of the alternatives available for people who have failed to respond to drug therapy and a U.S. study of 93 people compared the effectiveness of risperidone to a placebo in terms of delaying relapse and preventing it altogether. The group taking risperidone were just as likely to suffer a relapse as those taking a placebo but they did go over twice as long before becoming ill again as the placebo group.

Alexopoulos, George S. ... [et al] - Placebo-controlled study of relapse prevention with risperidone augmentation in older patients with resistant depression American Journal of Geriatric Psychiatry January 2008, 16(1), 21-30