Risperidone for young children with mood disorders and aggressive behavior

Open clinical treatment with risperidone was administered to a clinically heterogeneous group of 11 children and adolescents (age range 5.5-16 years, mean 9.8 years) with concurrent presentation of affective symptoms (mostly suggestive of bipolar disorder), aggressive and violent behavior, and marked management problems. These patients had responded inadequately to several mood-stabilizing medications. In this outpatient sample, 8 of 11 children (73%) appeared to have therapeutic responses to risperidone. Risperidone doses were low (0.75-2.5 mg daily) and clinical responses were observed at times within days of receiving the medication. Improvement was clinically judged to be moderate to marked in 7 of 8 children. In addition, the treatment of 2 children was stopped because of drowsiness; one also experienced a weight gain of 6 kg (13 lbs). An additional child with autism and aggressive behavior who lacked affective symptoms did not respond to risperidone. None of the children showed behavioral deterioration. Seven of the 8 responders were taking concurrent medications; including 4 on mood-stabilizing medications (either lithium, carbamazepine, or valproic acid) in subtherapeutic doses. Even in combination with other medications, side effects at these doses were minimal and limited to mild sedation and, at times, troubling weight gain. Pending controlled studies, these preliminary findings suggest that risperidone--alone or in combination with mood stabilizers--may be of value in treating children and adolescents with mood disorders (especially subthreshold bipolar disorder) and aggressive behavior.