Separation anxiety in children and adolescents treated with risperidone

Risperidone is an atypical antipsychotic that has been investigated as a treatment for several severe psychiatric disorders in children and adults. A low dose of risperidone was added to other medications to treat two adolescent boys with obsessive compulsive disorder (OCD) and a childhood history of separation anxiety disorder, and one prepubertal boy with a history of attention deficit hyperactivity disorder and escalating behavior suggestive of mania. Each patient developed severe separation anxiety that resolved when risperidone was discontinued. The response was similar to that described in Tourette's disorder patients treated with haloperidol and pimozide. Two of the patients were treated subsequently with olazapine without a recurrence of separation anxiety. We discuss the diagnostic issues concerning separation anxiety induced by antipsychotic medications, and suggest that the atypical antipsychotics may differ in their tendency to elicit separation anxiety.