Inpatient Treatment of Severe Disruptive Behaviour Disorders with Risperidone and Milieu Therapy

• Published in: Canadian journal of psychiatry Vol. 45; no. 4; pp. 376 - 382
• Main Authors: Ad-Dab'bagh, Yasser, Greenfield, Brian, Milne-Smith, Jennifer, Freedman, Hyman
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-05-2000; Canadian Psychiatric Association; SAGE PUBLICATIONS, INC
• Subjects: Adolescent; Antipsychotic Agents - therapeutic use; Associated treatments; Behavior disorders; Biological and medical sciences; Child; Child Behavior Disorders - diagnosis; Child Behavior Disorders - therapy; Child, Preschool; Children & youth; Combined Modality Therapy; Female; Humans; Male; Medical sciences; Milieu therapy; Milieu Therapy - methods; Psychology; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Retrospective Studies; Risperidone - therapeutic use; Severity of Illness Index; Treatment; Treatments; disruptive behaviour disorders; milieu therapy; children; borderline disorders; multiple complex developmental disorder; risperidone; Human; Borderline; Institutional therapy; Neuroleptic; Psychotropic; Dopamine receptor; Toxicity; Dopamine antagonist; Serotonin antagonist; Treatment efficiency; Hospital environment; Serotonine receptor; Personality disorder; Preadolescent; Dose activity relation; Chemotherapy; Treatment; Follow up study; Prepuberty; Combined treatment; Antagonist; Risperidone; Social behavior disorder
• ISSN: 0706-7437; 1497-0015
• DOI: 10.1177/070674370004500407

Objectives:
To evaluate the therapeutic impact of adding risperidone to milieu therapy of latency-aged inpatients with severe disruptive disorders.
Methods:
The charts of 90 latency-aged patients consecutively admitted to a psychiatry ward were reviewed retrospectively. Fifteen of these patients received 0 risperidone treatment, were nonpsychotic, and did not suffer from pervasive developmental disorder (12 male, 3 female; mean age 9.99 years, SD 1.76). Their scores on the Children's Global Assessment Scale (CGAS) were compared at admission, before risperidone treatment, and at discharge.
Results:
All subjects were diagnosed with a disruptive behavioural disorder. Ten (66.67%) had additional learning difficulties, and 13 (86.7%) had pathological personality traits. The characteristics of the sample suggested borderline pathology or multiple complex developmental disorder. Following a mean of 38 days after admission (SD 22.3), the patients received risperidone for a mean of 46 days (SD 28.2) before being discharged. The mean maintenance dose of risperidone was 1.27 mg daily (SD 0.36). Mean CGAS scores increased from admission (21.9, SD 7.0) to before risperidone treatment (26.8, SD 7.6, P < 0.0001) and to discharge (50.3, SD 5.3, P < 0.0001). Only 2 patients had documented side effects.
Conclusions:
Low-dose risperidone used adjunctively to milieu therapy led to statistically and clinically significant additional improvement in the functioning of hospitalized latency-aged children with severe behavioural disorders. Low-dose risperidone is a safe and effective adjunct to milieu therapy for treating this population in inpatient settings. Prospective randomized controlled trials are needed to confirm these findings.