Introduction: The aim of this prospective naturalistic study was to examine for the first time the relationship between dosage, serum concentration and clinical outcome in children and adolescents with impulsive-aggressive symptoms during risperidone therapy.
Methods: Steady state trough serum concentrations of risperidone and 9-hydroxyrisperidone (the active moiety) were measured in 103 subjects. The therapeutic effect was assessed by the clinical global impression improvement subscale and side effects by the Udvalg for Kliniske Undersogelser-side effect rating scale.
Results: We found a linear relationship between the risperidone dose and the serum concentration of the active moiety (Spearman ρ=0.53) and no correlation between the serum concentration and either the therapeutic effect or side effects. There was no effect of gender and co-medication.
Discussion: This study has the typical limitations of naturalistic studies, therefore our results should be interpreted with caution. Based on the serum concentrations at the therapeutically effective dose range (0.25–1.5 mg/day) we obtained first information on a possibly appropriate therapeutic serum range for the risperidone treatment of children and adolescents with impulsive-aggressive symptoms. Further studies with greater sample sizes are needed to validate our results and to examine the influence of genetic polymorphisms on the serum concentration of risperidone.
References
1
Aman MG, Tassé MJ, Rojahn J. et al .
The Nisonger CBRF: A child behavior rating form for children with developmental disabilities.
Research in Developmental Disabilities.
1996;
17
41-57
2
Aman MG, De Smedt G, Derivan A. et al .
Risperidone Disruptive Behavior Study Group
Double-blind, placebo-controlled study of risperidone for the treatment of disruptive behaviors in children with subaverage intelligence.
Am J Psychiatry.
2002;
159
1337-1346
3
Aman MG, Binder C, Turgay A.
Risperidone effects in the presence/absence of psychostimulant medicine in children with ADHD, other disruptive behavior disorders, and subaverage IQ.
J Child Adolesc Psychopharmacol.
2004;
14
243-254
5
Aravagiri M, Marder SR, Wirshing D. et al .
Plasma concentrations of risperidone and its 9-hydroxy metabolite and their relationship to dose in schizophrenic patients: Simultaneous determination by a high performance liquid chromatography with electrochemical detection.
Pharmacopsychiatry.
1998;
31
102-109
6
Aravagiri M, Marder SR, Nuechterlein KH. et al .
Intra- and interindividual variations in steady-state plasma concentrations of risperidone and 9-hydroxyrisperidone in schizophrenic patients treated chronically with various doses of risperidone.
Ther Drug Monit.
2003;
25
657-664
7
Baumann P, Hiemke C, Ulrich S. et al .
The AGNP-TDM expert group consensus guidelines. Therapeutic drug monitoring in psychiatry.
Pharmacopsychiatry.
2004;
37
243-265
9 Clement HW, Taram C, Fleischhaker C. et al .Bestimmung und Wirkung der Höhe des Serumspeigels von Risperidon und 9-Hydroxyrisperidon in einem Kollektiv von Kindern und Jugendlichen. In: Schulte-Markwort M, editor Psychosomatik- Kinder- und Jugendpsychiatrie als interdisziplinäres Fach, Medizinisch Wissenschaftliche Verlagsgesellschaft 2009
10
De Leon J, Susce MT, Pan RM. et al .
A study of genetic (CYP2D6 and ABCB1) and environmental (drug inhibitors and inducers) variables that may influence plasma risperidone levels.
Pharmacopsychiatry.
2007;
40
93-102
11
Farde L, Nordström AL, Wiesel FA. et al .
Positron emission tomographic analysis of central D1 and D2 dopamine receptor occupancy in patients treated with classical neuroleptics and clozapine Relation to extrapyramidal side effects.
Arch Gen Psychiatry.
1992;
49
538-544
12
Findling RL, McNamara NK, Branicky LA. et al .
A double-blind pilot study of risperidone in the treatment of conduct disorder.
J Am Acad Child Adolesc Psychiatry.
2000;
39
509-516
15
Gerlach M, Rothenhöfer S, Mehler-Wex C. et al .
Therapeutic drug monitoring in child and adolescent psychiatry practical recommendations.
Z Kinder Jugendpsychiatr Psychother.
2006;
34
5-13
16
Gründer G, Fellows C, Janouschek H. et al .
Brain and plasma pharmacokinetics of aripiprazole in patients with schizophrenia: An [18F]fallypride PET study.
Am J Psychiatry.
2008;
165
988-995
19
Kapur S, Zipursky RB, Remington G.
Clinical and theoretical implications of 5-HT2 and D2 receptor occupancy of clozapine, risperidone, and olanzapine in schizophrenia.
Am J Psychiatry.
1999;
156
286-293
20
Kirschbaum KM, Finger S, Vogel F. et al .
High performance-liquid chromatography with column-switching and spectro–photometric detection for determination of risperidone and 9-hydroxyrisperidone in human serum.
Chromatographia.
2008;
67
321-324
21
Lingjaerde O, Ahlfors UG, Bech P. et al .
The UKU side effect rating scale. A new comprehensive rating scale for psychotropic drugs and a cross-sectional study of side effects in neuroleptic-treated patients.
Acta Psychiatr Scand.
1987;
334
1-100
22
Maughan B, Rowe R, Messer J. et al .
Conduct disorder and oppositional defiant disorder in a national sample: Developmental epidemiology.
J Child Psychol Psychiatry.
2004;
45
609-621
23
Mauri MC, Volonteri LS, Colasanti A. et al .
Clinical pharmacokinetics of atypical antipsychotics: a critical review of the relationship between plasma concentrations and clinical response.
Clin Pharmacokinet.
2007;
46
359-388
24
McCracken JT, McGough J, Shah B. et al .
Research Units on Pediatric Psychopharmacology Autism Network. Risperidone in children with autism and serious behavioral problems.
N Engl J Med.
2002;
347
314-321
26
Mehler-Wex C, Kölch M, Kirchheiner J. et al .
Drug monitoring in child and adolescent psychiatry for improved efficacy and safety of psychopharmacotherapy.
Child and AdolescPsychiatry Ment Health.
2009;
3
14
27
Nock MK, Kazdin AE, Hiripi E. et al .
Lifetime prevalence, correlates, and persistence of oppositional defiant disorder: Results from the National Comorbidity Survey Replication.
J Child Psychol Psychiatry.
2007;
48
703-713
28
Olesen O, Licht R, Thomsen E. et al .
Serum concentrations and side effects in psychiatric patients during risperidone therapy.
Therapeutic Drug Monitoring.
1998;
20
380-384
29
Pappadopulos E, Woolston S, Chait A. et al .
Pharmacotherapy of aggression in children and adolescents: Efficacy and effect size.
Can Acad Child Adolesc Psychiatry.
2006;
15
27-39
30
Ricci LA, Connor DF, Morrison R. et al .
Risperidone exerts potent anti-aggressive effects in a developmentally immature animal model of escalated aggression.
Biol Psychiatry.
2007;
62
218-225
31
Schwartzer JJ, Connor DF, Morrison RL. et al .
Repeated risperidone administration during puberty prevents the generation of the aggressive phenotype in a developmentally immature animal model of escalated aggression.
Physiol Behav.
2008;
95
176-181
32
Snyder R, Turgay A, Aman M. et al .
Risperidone Conduct Study Group. Effects of risperidone on conduct and disruptive behavior disorders in children with subaverage IQs.
J Am Acad Child Adolesc Psychiatry.
2002;
41
1026-1036
33
Turgay A, Binder C, Snyder R. et al .
Long-term safety and efficacy of risperidone for the treatment of disruptive behaviour disorders in children with subaverage IQs.
Pediatrics.
2002;
110
34