Inpatient treatment of severe disruptive behaviour disorders with risperidone and milieu therapy

Objectives: To evaluate the therapeutic impact of adding risperidone to mil ieu therapy, of latency-aged inpatients with severe disruptive disorders. Methods: The charts of 90 latency-aged patients consecutively admitted to a psychiatry warn were reviewed retrospectively. Fifteen of these patients r eceived risperidone treatment, were nonpsychotic, and did not suffer from p ervasive developmental disorder (12 male, 3 female; mean age 9.99 years, SD 1.76). Their scores on the Children's Global Assessment Scale (CGAS) were compared at admission, before risperidone treatment, ann at discharge. Results: All subjects were diagnosed with a disruptive behavioural disorder . Ten (66.67%) had additional learning difficulties, and 13 (86.7%) had pat hological personality traits. The characteristics of the sample suggested b orderline pathology or multiple complex developmental disorder. Following a mean of 38 days after admission (SD 22.3), the patients received risperido ne for a mean of 46 days (SD 28.2) before being discharged The mean mainten ance dose of risperidone was 1.27 mg daily (SD 0.36). Mean CGAS scores incr eased from admission (21.9, SD 7.0) to before risperidone treatment (26.8 S D 7.6 P < 0. 0001) and to discharge (50.3, SD 5.3, P < 0.0001). Only 2 pati ents had documented side effects. Conclusions: Low-dose risperidone used adjunctively to milieu therapy led t o statistically and clinically significant additional improvement in the fu nctioning of hospitalized latency-aged children with severe behavioral diso rders. Low-nose risperidone is a safe and effective adjunct to milieu thera py for treating this population in inpatient settings. Prospective randomiz ed controlled trials are needed to confirm these findings.