title: Risperidone, haloperidol, and placebo in the treatment of aggressive challenging behaviour in patients with intellectual disability: a randomised controlled trial.
abstract: BACKGROUND
  Aggressive challenging behaviour is frequently reported in adults with intellectual disability and it is often treated with antipsychotic drugs. However, no adequate evidence base for this practice exists. We compared flexible doses of haloperidol (a typical, first-generation antipsychotic drug), risperidone (an atypical, second-generation antipsychotic), and placebo, in the treatment of this behaviour.
  
  
  METHODS
  86 non-psychotic patients presenting with aggressive challenging behaviour from ten centres in England and Wales, and one in Queensland, Australia, were randomly assigned to haloperidol (n=28), risperidone (n=29), or placebo (n=29). Clinical assessments of aggression, aberrant behaviour, quality of life, adverse drug effects, and carer uplift (positive feelings about the care of the disabled person) and burden, together with total costs, were recorded at 4, 12, and 26 weeks. The primary outcome was change in aggression after 4 weeks' treatment, which was recorded with the modified overt aggression scale (MOAS). Analysis was by intention to treat. This study is registered as ISRCTN 11736448.
  
  
  RESULTS
  80 patients had adherence of 80% or more to prescribed drug. Aggression decreased substantially with all three treatments by 4 weeks, with the placebo group showing the greatest change (median decrease in MOAS score after 4 weeks=9 [95% CI 5-14] for placebo, 79% from baseline; 7 [4-14] for risperidone, 58% from baseline; 6.5 [5-14] for haloperidol, 65% from baseline; p=0.06). Furthermore, although no important differences between the treatments were recorded, including adverse effects, patients given placebo showed no evidence at any time points of worse response than did patients assigned to either of the antipsychotic drugs.
  
  
  CONCLUSIONS
  Antipsychotic drugs should no longer be regarded as an acceptable routine treatment for aggressive challenging behaviour in people with intellectual disability.
authors.affiliation: Department of Psychological Medicine, Imperial College, London, UK. p.tyrer@imperial.ac.uk
authors.forename: Peter
authors.initials: P
authors.lastname: Tyrer
authors.forename: Patricia C
authors.initials: PC
authors.lastname: Oliver-Africano
authors.forename: Zed
authors.initials: Z
authors.lastname: Ahmed
authors.forename: Nick
authors.initials: N
authors.lastname: Bouras
authors.forename: Sherva
authors.initials: S
authors.lastname: Cooray
authors.forename: Shoumitro
authors.initials: S
authors.lastname: Deb
authors.forename: Declan
authors.initials: D
authors.lastname: Murphy
authors.forename: Monica
authors.initials: M
authors.lastname: Hare
authors.forename: Michael
authors.initials: M
authors.lastname: Meade
authors.forename: Ben
authors.initials: B
authors.lastname: Reece
authors.forename: Kofi
authors.initials: K
authors.lastname: Kramo
authors.forename: Sabyasachi
authors.initials: S
authors.lastname: Bhaumik
authors.forename: David
authors.initials: D
authors.lastname: Harley
authors.forename: Adrienne
authors.initials: A
authors.lastname: Regan
authors.forename: David
authors.initials: D
authors.lastname: Thomas
authors.forename: Bharti
authors.initials: B
authors.lastname: Rao
authors.forename: Bernard
authors.initials: B
authors.lastname: North
authors.forename: Joseph
authors.initials: J
authors.lastname: Eliahoo
authors.forename: Shamshad
authors.initials: S
authors.lastname: Karatela
authors.forename: Anju
authors.initials: A
authors.lastname: Soni
authors.forename: Mike
authors.initials: M
authors.lastname: Crawford
mesh_terms: D000328:Adult; D000368:Aged; D000374:Aggression / Q000187:drug effects*; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006220:Haloperidol / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D016743:Mental Competency; D001523:Mental Disorders / Q000188:drug therapy*; D008875:Middle Aged; D010349:Patient Compliance; D018967:Risperidone / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D014150:Antipsychotic Agents; D006220:Haloperidol; D018967:Risperidone