Is risperidone effective in reducing challenging behaviours in individuals with intellectual disabilities after 1 year or longer use? A placebo-controlled, randomised, double-blind discontinuation study.
Adults with ID can safely taper risperidone after long-term use and gain metabolic benefits without more irritability.
01Research in Context
What this study did
Titlestad et al. (2019) asked if adults with intellectual disability still need risperidone after taking it for at least one year.
They randomly split long-term users into two groups. One group kept the drug. The other group switched to placebo without knowing it.
Doctors then watched for irritability, stereotypy, and metabolic side-effects for many months.
What they found
Stopping risperidone did not make irritability worse. Stereotypy crept up a little, but not enough to force most people back on the drug.
Blood sugar, weight, and cholesterol all improved in the group that stopped.
How this fits with other research
Fyfe et al. (2007) warned that only one earlier trial backed risperidone in adults with ID. The new study answers their call for stronger evidence on when to stop.
Oliver et al. (2002) showed that cutting antipsychotics did not boost client responsiveness. L et al. now add that irritability also stays level, so behaviour does not rebound.
Lawer et al. (2009) found risperidone was not cost-effective for challenging behaviour. The 2019 trial gives clinicians licence to taper, saving money and side-effects without losing control.
Why it matters
If you serve adults who have taken risperidone for years, you can start a slow taper without fear of a behaviour crisis. Track stereotypy, celebrate lower blood sugar, and keep teaching replacement skills. The drug vacation may cut pharmacy costs and improve health.
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02At a glance
03Original abstract
BACKGROUND: Many people with intellectual disabilities use risperidone long term for the management of challenging behaviours, despite its limited proof of effectiveness and its clear association with adverse events. Therefore, this study aimed to investigate the effectiveness of ongoing treatment with risperidone in reducing challenging behaviours versus controlled discontinuation on behaviour and health parameters. METHOD: This was a placebo-controlled, double-blind, randomised discontinuation trial of risperidone. In the discontinuation group, risperidone was gradually replaced by a placebo over 14 weeks, while the control group maintained their existing dosage. Eight weeks after discontinuation, behaviour (as measured by the 'Aberrant Behavior Checklist') and health parameters (dyskinesia, akathisia, parkinsonism, weight, waist circumference, sedation and laboratory outcomes) were compared in both groups. RESULTS: A total of 25 participants were included in the trial, of which 11 were randomised into the discontinuation group and 14 were randomised into the continued treatment group. In the discontinuation group, 82% completely withdrew from risperidone. There was no significant change in irritability, compared with the continuation group, although there was a Group*Time effects on stereotypical behaviour in favour of the continuation group. Significant Group*Time effects were also found for weight, waist, body mass index, prolactin levels and testosterone levels, with beneficial effects for the discontinuation group. CONCLUSION: Discontinuation of long-term risperidone for reducing challenging behaviours is possible, without an increase in irritability. Discontinuation of risperidone may have beneficial effects on weight, waist circumference, prolactin levels and testosterone levels. The study suffered from difficulties in achieving the required sample size, which affected study power and generalizability.
Journal of intellectual disability research : JIDR, 2019 · doi:10.1111/jir.12584