The quality of evidence is downgraded by study limitations (unclear allocation concealment and blinding of outcome assessors), and by imprecise results (few patients).
A Cochrane review [Abstract] 1 included 10 studies with a total of 896 subjects (between 5 and 18 years of age) with disruptive behaviour disorders. Eight trials assessed risperidone, one assessed quetiapine and one assessed ziprasidone. Nine trials assessed acute efficacy (over four to 10 weeks); one of which combined treatment with stimulant medication and parent training. One trial was a six-month maintenance trial assessing symptom recurrence.
Youths treated with risperidone showed reduced aggression compared to youths treated with placebo (MD −6.49, 95% confidence interval (CI) −8.79 to −4.19; low-quality evidence). Using the standardised mean difference (SMD), we pooled data from two risperidone trials (190 participants), which used different scales: the Overt Aggression Scale‒ Modified (OAS-M) Scale and the Antisocial Behaviour Scale (ABS); as the ABS had two subscales that could not be combined (reactive and proactive aggression), two separate analyses were performed. When combined the ABS Reactive subscale and the OAS-M, the SMD was −1.30 in favour of risperidone (95% CI −2.21 to −0.40, moderate-quality evidence). When we combined the ABS Proactive subscale and OAS-M, the SMD was −1.12 (95% CI −2.30 to 0.06, moderate-quality evidence), suggesting uncertainty about the estimate of effect, as the confidence intervals overlapped the null value. In summary, there was some evidence that aggression could be reduced by risperidone. Data were lacking on other atypical antipsychotics, like quetiapine and ziprasidone, with regard to their effects on aggression.
Data pooled from two risperidone trials (225 participants) in a meta-analysis of conduct problems, as assessed using the Nisonger Child Behaviour Rating Form ‒ Conduct Problem subscale (NCBRF-CP). This yielded a final mean score that was 8.61 points lower in the risperidone group compared to the placebo group (95% CI −11.49 to −5.74; moderate-quality evidence).The effect on weight was investigated by performing two meta-analyses. Pooling two trials with risperidone only (138 participants), participants on risperidone gained 2.37 kilograms (kg) more (95% CI 0.26 to 4.49; moderate-quality evidence) than those on placebo. When all participants received a combination of risperidone and stimulants, those on the combined treatment gained 2.14 kg more (95% CI 1.04 to 3.23; 3 studies; 305 participants; low-quality evidence) than those on placebo.
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