Antipsychotics for aggressive youth:
Are they effective, and are they safe?
Schur SB, Sikich L, Findling RL, Malone R, Crismon ML, Derivan A, et al
The Bottom Line:
There are only very few controlled trials of the use of either typical or atypical antipsychotic medications in children or adolescents. The best evidence is for risperidone, which works well to treat aggression in children and adolescents and has a relatively good safety profile. These drugs must be used with caution and careful monitoring, given the limited research on them. |
What problem is being addressed?
Aggressive behavior in children and adolescents disrupts family life, contributes to classroom chaos, and produces fear in the community. Young people who act out aggressively are also a threat to themselves. They take risks and engage in activities that could cause themselves injury. Finding the best ways to reduce aggression in this age group can have positive, long-term consequences both for the youth themselves and society as a whole.
What intervention is being tested?
This is a review of the research literature on the use of antipsychotic medications to treat aggressive behavior in children and adolescents. The review assessed the evidence for the safety and effectiveness of haloperidol and pimozide (so-called typical antipsychotics) and risperidone, olanzapine, clozapine, quetiapine, and ziprasidone (all atypical antipsychotics).
Antipsychotic medications, which are thought to affect brain chemistry involved in producing anger and aggression, have been used for many years to treat the impulsive behavior and irritability that may lead to aggression.
What is the real scientific evidence?
This is a review of the research literature on the use of antipsychotic medications to treat aggressive behavior in children and adolescents. The review assessed the evidence for the safety and effectiveness of haloperidol and pimozide (so-called typical antipsychotics) and risperidone, olanzapine, clozapine, quetiapine, and ziprasidone (all atypical antipsychotics).
Antipsychotic medications, which are thought to affect brain chemistry involved in producing anger and aggression, have been used for many years to treat the impulsive behavior and irritability that may lead to aggression.
What is the real scientific evidence?
Haloperiodol and pimozide were shown to be effective in reducing aggression in children and adolescents but their safety in this age group is questionable. As a result, their use as a standard treatment has declined.
Risperidone has had the largest number of studies done. They have shown the drug to be effective in children and adolescents with aggressive behavior, including those with low intelligence or with psychotic symptoms. A significant side effect in risperidone is weight gain and some teenagers developed mild, temporary extrapyramidal symptoms (EPS), but at a much lower rate than is seen with typical antipsychotics.
Clozapine appears to be effective in reducing aggression in children and adolescents but it can have serious side effects, including a blood disorder, seizures, weight gain, and abnormally high heart rate.
The evidence for the effectiveness of olanzapine is inconclusive, and the drug can produce serious side effects including problems with high blood sugar, blood fats, and the development of diabetes.
There is a lack of data showing that quetiapine is either safe or effective in children and adolescents.
Ziprasidone has not been studied in aggression.
The preceding is a summary of:
Schur SB, Sikich L, Findling RL, Malone R, Crismon ML, Derivan A, et al. Treatment Recommendations for the Use of Antipsychotics for Aggressive Youth (TRAAY). Part I: A Review. Journal of the American Academy of Child and Adolescent Psychiatry 2003, 42(2): 132-144.
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