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Risperidone, Haloperidol & Placebo in Tt of Aggressive Challenging Behaviour in pts with Intellectual Disability

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Risperidone, Haloperidol & Placebo in Tt of Aggressive Challenging Behaviour in pts with Intellectual Disability

Post  Admin on Tue Aug 30, 2011 9:46 pm

Risperidone, Haloperidol & Placebo in the treatment of aggressive challenging behaviour in patients with intellectual disability

Lancet 2008; 371: 57–63

Aggressive challenging behaviour is frequently reported in adults with intellectual disability and it is often treated with antipsychotic drugs. However, no adequate evidence base for this practice exists.
This study compared flexible doses of haloperidol (a typical, first-generation antipsychotic drug), risperidone (an atypical, second-generation antipsychotic), and placebo, in the treatment of this behavior.

Clinical assessments of Aggression, Aberrant behavior, Quality of life, Adverse drug effects, and Carer uplift (positive feelings about the care of the disabled person) and burden, together with total costs, were recorded at 4, 12, and 26 weeks.

Aggression decreased substantially with all three treatments by 4 weeks, with the placebo group showing the greatest change.
Furthermore, no differences was recorded between groups in terms of aberrant behaviour, quality of life, general improvement, effect on carers, and adverse drug effects.
The many practitioners involved in the study used doses that were lower than those used for similar purposes in adult psychiatry, since people with intellectual disability are sensitive to adverse effects.

The absence of any significant differences between drugs on any of the other secondary outcomes reinforces the conclusion that the antipsychotic drugs were of no selective benefit.
This trial has shown that aggressive challenging behavior in people with intellectual disability decreases whether or not active medication is given. The tendency for clinicians to give steadily reduced doses of antipsychotic drugs in such instances is then understandable, since the lower the dose the nearer the approximation to a placebo effect.

Study conclude that the routine prescription of antipsychotic drugs early in the management of aggressive challenging behaviour, even in low doses, should no longer be regarded as a satisfactory form of care.

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