Risperidone and cognitive function in children with disruptive behavior disorders
ABSTRACT Effects of risperidone on cognitive function in children with disruptive behavior disorders (DBDs) and subaverage intelligence quotient (IQ) were assessed.
Data from two 6-week, double-blind, placebo-controlled studies (n = 228) were combined, as were three 1-year, open-label studies (n = 688). Patients with DBDs and subaverage IQ, 5 to14 years, received placebo or risperidone .02 to .06 mg/kg/day. Cognitive measures included the Continuous Performance Task (CPT) and Verbal Learning Test for Children (VLT-C). Efficacy was assessed using the Nisonger Child Behavior Rating Form (NCBRF). Adverse events were collected via spontaneous report; sedation was assessed using visual analog scale.
Improvements on the NCBRF Conduct Problem subscale were significantly greater for risperidone- versus placebo-treated patients (-15.8 vs. -6.4, p < .0001) in short-term studies; significant reductions were observed in long-term studies (-16.3, p < .0001). No overall decline and some significant improvement in attention (CPT) and memory (VLT-C) were noted regardless of treatment in short-term studies. VLT-C improved significantly (p < .0001) for both groups, with no difference between treatment groups. Improvements in memory (VLT-C) and attention (CPT) were noted in long-term studies. Somnolence/sedation did not affect cognitive function.
Cognitive function was not altered by risperidone in short-term studies and was maintained or improved with one year of treatment in children with DBDs and subaverage IQ, potentially representing age-appropriate gains.
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- "Atypical antipsychotic drugs, called second-generation antipsychotics (SGAs), have been shown to be effective in controlling aggressive and externalizing behaviors, as well as bipolar disorder in pediatric populations (Bishop and Pavuluri 2008; Pandina et al. 2007, 2009). All SGAs target the thalamic–striatal–frontal loop, which has been shown to be important in several cognitive functions such as rewardbased learning (Schultz 2002), cognitive flexibility (Cools 2006), and working memory (Kellendonk et al. 2006). "
ABSTRACT: Atypical antipsychotic drugs are characterized by their affinity for serotonin and dopamine receptors. The dopaminergic system undergoes developmental changes during childhood, making it vulnerable to external influences such as drug administration. The purpose of this study was to assess the long-term effects of administering risperidone and quetiapine to 12-24-month-old macaque monkeys on cognitive development, a maturational equivalent to 4-8-year-old children. Forty male pigtailed macaques were used in the study (n = 20 placebo, n = 10 risperidone, n = 10 quetiapine). Following a 4-month pre-drug period, animals were orally administered 2 mg/kg of quetiapine and .025 mg/kg of risperidone daily for 4 months, then the dosage was doubled for another 4 months. They were followed up for 4 months after cessation of the drug. Animals were assessed through all phases of the study on two-object discrimination and learning set. Cognitive development was not negatively affected while the animals were being administered the drug. However, the risperidone group had significant decrements in performance on the learning set task after cessation of the drug (p = 0.006, η (p) (2) = 0.59). Analysis of errors showed that the risperidone group had a significant increase in perseverative responding during the post-drug phase (p = 0.002, η (p) (2) = 0.67). As with human studies, neither risperidone nor quetiapine had a negative impact on cognitive development during the drug phases. However, the results show that the risperidone group had behavioral impairment post-drug, suggesting that the drug may have impacted the development of the dopaminergic system.Psychopharmacology 05/2011; 215(2):345-52. DOI:10.1007/s00213-010-2147-6 · 3.99 Impact Factor
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- "However, in Troost et al. (2006) and in the present study, aspects of memory and attention did improve (Troost et al., characterized their divided attention task as an index of working memory.) Findings for the Verbal Learning test differed from the Pandina (2007) study in that we observed enhanced word recognition with risperidone, but Pandina et al. did not. (However, Pandina et al. did report improvements in uncontrolled one year open-label extension studies.) "
ABSTRACT: The objective of this research was to explore the effects of risperidone on cognitive processes in children with autism and irritable behavior. Thirty-eight children, ages 5-17 years with autism and severe behavioral disturbance, were randomly assigned to risperidone (0.5 to 3.5 mg/day) or placebo for 8 weeks. This sample of 38 was a subset of 101 subjects who participated in the clinical trial; 63 were unable to perform the cognitive tasks. A double-blind placebo-controlled parallel groups design was used. Dependent measures included tests of sustained attention, verbal learning, hand-eye coordination, and spatial memory assessed before, during, and after the 8-week treatment. Changes in performance were compared by repeated measures ANOVA. Twenty-nine boys and 9 girls with autism and severe behavioral disturbance and a mental age >or=18 months completed the cognitive part of the study. No decline in performance occurred with risperidone. Performance on a cancellation task (number of correct detections) and a verbal learning task (word recognition) was better on risperidone than on placebo (without correction for multiplicity). Equivocal improvement also occurred on a spatial memory task. There were no significant differences between treatment conditions on the Purdue Pegboard (hand-eye coordination) task or the Analog Classroom Task (timed math test). Risperidone given to children with autism at doses up to 3.5 mg for up to 8 weeks appears to have no detrimental effect on cognitive performance.Journal of child and adolescent psychopharmacology 06/2008; 18(3):227-36. DOI:10.1089/cap.2007.0133 · 3.07 Impact Factor
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- "Although associated with cognitive benefits in adults with schizophrenia , the cognitive effects of these agents in children and adolescents have not been systematically evaluated (Pandina et al. 2003). A 6-week trial comparing risperidone and placebo in 118 children and adolescents with disruptive behavioral disorders evaluated memory, using the Modified Verbal Learning Test—Children's Version (MVLT-CV), and attention and vigilance using the Continuous Performance Test (CPT) (Pandina et al. 2003). Both the risperidone and placebo groups showed significant improvements in memory from baseline to endpoint, with no significant differences between groups. "
ABSTRACT: The aim of this paper was to discuss the arguments for and against the use of atypical antipsychotics in children and adolescents with aggression, and provide recommendations for future research. A MEDLINE search (1985-2004) was performed to identify key literature. Search terms included, but were not limited to, clozapine, olanzapine, quetiapine, risperidone, ziprasidone, children, and adolescents. The search was limited to English-language literature and randomized controlled trials. The use of atypical antipsychotics in children and adolescents has increased significantly over the past few years. Atypical antipsychotics are associated with a more favorable side-effect profile, and growing evidence supports their efficacy for aggression in this population. However, the long-term effects of these agents are unknown. No head-to-head evidence exists to suggest whether pharmacological or nonpharmacological treatments are superior for managing aggression associated with childhood and adolescent psychiatric and behavioral conditions. Future research of atypical antipsychotics in children and adolescents needs to evaluate not only the efficacy but also the effectiveness. Examination of treatment mediators and moderators may help to optimize treatment regimens and improve patient outcomes. Finally, effective interventions require the development and implementation of evidence-based treatment strategies using a multidisciplinary approach.Journal of Child and Adolescent Psychopharmacology 05/2005; 15(2):270-84. DOI:10.1089/cap.2005.15.270 · 3.07 Impact Factor