Maintenance therapy controls disruptive behavior

NEW YORK (Reuters Health) - In children and adolescents with disruptive behavior disorders who respond to initial treatment with risperidone, continuation of treatment can control symptoms for many over the long term, according to findings published in the American Journal of Psychiatry.

Dr. Magali Reyes from Johnson and Johnson Pharmaceutical Research and Development, Titusville, New Jersey, and colleagues compared the effects of risperidone maintenance therapy versus withdrawal in subjects with disruptive behavior disorders.

Patients between the ages of 5 and 17 years who had responded to risperidone treatment over 12 weeks were randomly assigned to 6 months of risperidone or placebo. Of 527 subjects treated initially, 335 were included in the maintenance trial.

Reyes's team found that 47 (27.3 percent) of patients treated with risperidone and 69 (42.3 percent) treated with placebo experienced symptom recurrence, a statistically significant difference.

The time to symptom recurrence was also significantly longer in patients continuing on risperidone compared with those treated with placebo -- 25 percent after 119 days and 37 days, respectively.

Discontinuation rates because of symptom recurrence, disruptive behavior disorder symptoms, and general function - also favored risperidone over placebo, according to the authors.

Headache, drowsiness, fatigue, and increased appetite were the most frequently reported treatment side effects. Most adverse events were mild to moderate. Overall, 1.7 percent of risperidone-treated patients and 0.6 percent of placebo-treated patients discontinued treatment during the maintenance phase.

Intellectual function, including verbal learning, memory and attention, was not affected by risperidone treatment, Reyes and colleagues point out.

The researchers conclude that maintenance therapy with risperidone improves symptoms of disruptive behavior disorder and conduct disorder symptoms, while preserving intellectual functioning. This finding is important because about 66 percent of the patients also had attention deficient hypertension disorder.

SOURCE: American Journal of Psychiatry, March 2006.