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Risperidona, haloperidol y placebo en el tratamiento del comportamiento agresivo desafiante en pacientes con
Peter Tyrer1, Patricia C Oliver-Africano, Zed Ahmed
1Department of Psychological Medicine, Imperial College, London, UK. p.tyrer@imperial.ac.uk
Lancet (London, England)
|January 8, 2008
Resumen
Los medicamentos antipsicóticos no mejoraron significativamente el comportamiento agresivo en adultos con discapacidad intelectual en comparación con el placebo. Estos hallazgos sugieren que los antipsicóticos no son un tratamiento de rutina adecuado para esta población.
Área de la Ciencia:
- Psicología Clínica Psicología clínica.
- Psicofarmacología y psicofarmacología.
- Discapacidad intelectual Investigación de la discapacidad intelectual.
Sus antecedentes:
- El comportamiento agresivo y desafiante es común en adultos con discapacidad intelectual.
- El uso de drogas antipsicóticas es frecuente para este comportamiento, pero falta evidencia.
- A menudo se prescriben antipsicóticos típicos (haloperidol) y atípicos (risperidona).
Objetivo del estudio:
- Para comparar la eficacia del haloperidol, la risperidona y el placebo en el tratamiento del comportamiento agresivo en adultos con discapacidad intelectual.
- Para evaluar cambios en la agresión, el comportamiento aberrante, la calidad de vida y los efectos adversos.
Principales métodos:
- Un ensayo controlado aleatorizado que involucró a 86 adultos no psicóticos con comportamiento agresivo desafiante.
- Los participantes fueron asignados a haloperidol, risperidona o placebo.
- Se realizaron evaluaciones de agresión (escala modificada de agresión abierta - MOAS), comportamiento, calidad de vida y efectos adversos durante 26 semanas.
Principales resultados:
- La agresión disminuyó significativamente en todos los grupos a las 4 semanas, con el grupo de placebo mostrando la mayor reducción (79% desde el inicio).
- No se encontraron diferencias significativas en la reducción de la agresión o los efectos adversos entre los grupos antipsicóticos y el placebo.
- Los pacientes que recibieron placebo no mostraron una respuesta peor que los que recibieron medicamentos antipsicóticos.
Conclusiones:
- Los medicamentos antipsicóticos no están respaldados por evidencia como un tratamiento de rutina para el comportamiento agresivo desafiante en individuos con discapacidad intelectual.
- El estudio cuestiona la práctica clínica actual de prescribir antipsicóticos para este grupo de pacientes.
- Se deben considerar intervenciones alternativas o no farmacológicas.
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