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Area of Science:

  • Psychiatry and Pharmacology
  • Clinical Trials and Evidence Synthesis

Background:

  • Aggressive and agitated behavior in psychosis necessitates rapid psychiatric interventions.
  • Risperidone is an accessible antipsychotic medication used for managing psychosis-induced aggression.

Purpose of the Study:

  • To evaluate the efficacy of oral risperidone as a monotherapy for psychosis-induced aggression or agitation.

Main Methods:

  • Systematic review of randomized controlled trials (RCTs) comparing oral risperidone with other treatments or placebo.
  • Searched comprehensive databases including MEDLINE, PubMed, PsycINFO, and Embase up to April 2017.
  • Data extraction and analysis included risk ratios and mean differences with 95% confidence intervals; risk of bias and GRADE approach were used.

Main Results:

  • Nine trials (n=582) provided data, but evidence quality was very low due to risk of bias and small trial sizes.
  • No significant differences were found between risperidone and haloperidol for agitation or need for restraints.
  • Limited data showed no clear benefit of risperidone over olanzapine or quetiapine for agitation; quetiapine showed a potential advantage for aggression.

Conclusions:

  • Current evidence suggests no significant effect of risperidone for psychosis-induced aggression or agitation.
  • The very low quality of available evidence necessitates caution in recommending risperidone for rapid tranquilization.
  • High-quality pragmatic RCTs are required to establish clear guidelines for using risperidone in managing psychosis-induced aggression.