Title: A Comparative Study on Efficacy of Risperidone versus Risperidone and Sodium Valproate Combination in the Treatment of Aggression in Children and Adolescents with Intellectual Disability

Authors: Aparna Ramakrishnan, Zara Ahmed2, Sanjiv Kale

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i5.137

Abstract

Introduction: Aggression is a symptom seen in multiple disorders. Children with Intellectual disability may exhibit aggression- harm to self, others or property. While Risperidone has been shown to produce significant reductions in aggression in youth, research has shown that mood stabilizers like Valproate can  reduce aggressive symptoms effectively. Few studies are available comparing efficacy of the two drugs – alone or in combination, in treatment of aggression in this population. This study compares efficacy of Risperidone versus Risperidone and Sodium valproate combination in treatment of aggression in children and adolescents with intellectual disability.

Materials and Methods: In this study,30 children and adolescents aged 4-17 years , diagnosed with Intellectual Disability (mild to moderate in severity ) and aggressive behaviour (as evaluated by Modified Overt Aggression Scale) (MOAS), treated with Risperidone were compared with 30 age matched children and adolescents with Intellectual Disability and Aggression ,on a combination of Risperidone and Sodium Valproate. Follow up evaluation of the groups using MOAS was conducted at 3 weeks, 6 weeks and 6 months of treatment. Data was statistically analyzed.

Results: Children and adolescents treated with Risperidone and Sodium Valproate combination showed significantly less verbal aggression and aggression towards property. No significant differences were found in the two groups in terms of Auto aggression and Physical aggression after 6 months. 

Conclusion: A combination of Sodium Valproate and Risperidone was better than Risperidone alone in decreasing verbal and aggression towards property in intellectually disabled children and adolescents.

Keywords: Aggression, Intellectual disability Risperidone Sodium Valproate.

References

  1. Munshi KR, Oken T, Guild DJ, Trivedi H et al. The use of antiepileptic drugs for treatment of Pediatric Aggression and Mood disorders. Pharmaceuticals (Basel). 2010. Sep;3(9): 2986-3004.
  2. Tremblay RE, Nagin DS,Seguin JR,Zoccolillo M et al. Physical aggression during early childhood : trajectories and predictors. Pediatrics. 2004 Jul ; 114(1): 43-50
  3. American Psychiatric association: Diagnostic and Statistical Manual of Mental Disorders, Fifth edition. Arlington VA, American Psychiatric association, 2013 : 33- 41
  4. Ageranioti – Belanger S, Brunet S, D’Anjou G, Tellier G et al. Behaviour disorders in children with an Intellectual Disability. Paediatr Child Health 2012; 17(2): 84-88
  5. Dekker MC, Koot HM, Van der Ende J, Verhulst FC. Emotional and behavioural problems in children and adolescents with and without intellectual disability. Journal of Child Psychology and Psychiatry. Nov 2002.Vol 43, Iss 8: 1087-1098
  6. Sturmey Peter. Treatment intervention for people with aggressive behaviour and Intellectual Disability. Autism and Related disorders. The basic handbook for Mental Health, primary care and other professionals. Editors – Geraldine Holt and Nick Bouras. 2002 produced on behalf of World Psychiatric Association by the Royal College of Psychiatrists : 42-56
  7. Eapen V, Gururaj AK. Risperidone treatment in 12 children with developmental disorders and Attention deficit/hyperactivity disorder. Prim Care Companion J Clin Psychiatry. 2005;7(5):221-224
  8. Capone GT, Goyal P,Grados M, Smith Bet al. Risperidone use in children with Down syndrome, severe intellectual disability and comorbid Autistic spectrum disorders : a naturalistic study. J Dev Behav Pediatr 2008:29: 106-116
  9. Aman MG,De Smedt G, Derivan A, Lyons B et al. Double blind placebo controlled study of Risperidone for the treatment of disruptive behaviours in children with subaverage intelligence. Am J of Psychiatry 2002; 159:1337-1346
  10. Shea S, Turgay A, Carrol A et al. Risperidone in the treatment of disruptive behavioural symptoms in children with Autistic and other pervasive developmental disorders.Peadiatrics 2004;114: e634-641
  11. Buitelaar JK, Van der Gaag RJ,Cohen- Kettenis P, Melman CT. A randomized controlled trial of Risperidone in the treatment of aggression in hospitalized adolescents with subaverage cognitive abilities. J. Clin Psychiatry. 2001. Apr;62(4) : 239-248
  12. Donovan SJ,Susser ES, Nunes EV, Stewart JW et al.Divalpraoex treatment of disruptive adolescents : a report of 10 cases. J Clin Psychiatry .1997 ;58: 12-15
  13. Donovan SJ, Stewart JW, Nunes EV, Quitkin FM et al. Divalpraoex treatment for youth with explosive temper and mood lability : a double blind, placebo controlled crossover design. Am .J. Psychiatry. 2000;157:818-820
  14. MacMillan CM, Korndorfer SR, Rao S, Fleisher CA et al. A comparison of Divalproaex and Oxcarbazepine in aggressive youth with Bipolar disorder. J.Psychiatr.Pract. 2006: 12 : 214-222
  15. Kowatch RA, Suppes T,Carmody TJ,Bucci J et al. Effect size of Lithium, Divalproaex Sodium and Carbamzepine in children and adolescents with bipolar disorder. J.Am.Acad.Child Adolesc. Psychiatry. 2000;39:713-720
  16. Hollander E, Chaplin W, Soorya L, Wasserman S et al. Divalproex sodium vs placebo for the treatment of irritability in children and adolescents with Autism Spectrum Disorders. Neuropsycho-pharmacology. 2010; 35: 990-998
  17. Huband N, Ferriter N, Nathan R, Jones H. Cochrane database system rev. 2010 Feb17; (2)

Corresponding Author

Aparna Ramakrishnan

Contact: 9819358626. Email: This email address is being protected from spambots. You need JavaScript enabled to view it.