title: Liquid risperidone in the treatment of rages in psychiatrically hospitalized children with possible bipolar disorder.
abstract: OBJECTIVE
  To examine the safety and efficacy of liquid risperidone to reduce duration of rages in children with severe mood dysregulation (SMD) or possible bipolar disorder (BP).
  
  
  METHODS
  The sample included 151 consecutive admissions of 5-12 year old children to a psychiatric inpatient unit. Diagnostic information and history of prior rage outbursts were obtained at admission. In hospital, a first rage was treated with seclusion. If a second rage occurred, the child was offered liquid risperidone to help him/her regain control. Durations of unmedicated and last medicated rage were compared. Rage frequency in children with SMD and several definitions of BP were compared.
  
  
  RESULTS
  Although 82 of 151 admissions were prompted by rages, rages occurred during only 49 hospitalizations and occurred more than once in only 24. In 16 multiply medicated children, duration of rages dropped from a baseline of 44.4 +/- 20.2 min to 25.6 +/- 12.5 min at the child's last dose. Neither SMD nor any definition of BP influenced rage response in this small sample. The average liquid risperidone dose was 0.02 mg/kg. All but two children also took atypical antipsychotics daily. In the evaluation of medicated rage episodes with standard rating scales, no extrapyramidal side effects, akathisia, or abnormal involuntary movements were observed, and the rate of sedation/sleepiness (7/67 = 10.4%) was similar and not significantly different from that observed during nonmedicated episodes (8/46 = 17.4%).
  
  
  CONCLUSIONS
  Liquid risperidone may be a safe and effective way to shorten the duration of rage episodes regardless of diagnosis. However, definitive conclusions cannot be drawn in the absence of a placebo control as children were also receiving other behavioral and psychopharmacologic treatments.
authors.affiliation: Division of Child and Adolescent Psychiatry, Stony Brook University School of Medicine, Stony Brook, NY 11794-8790, USA. gabrielle.carlson@stonybrook.edu
authors.forename: Gabrielle A
authors.initials: GA
authors.lastname: Carlson
authors.forename: Michael
authors.initials: M
authors.lastname: Potegal
authors.forename: David
authors.initials: D
authors.lastname: Margulies
authors.forename: Joann
authors.initials: J
authors.lastname: Basile
authors.forename: Zinoviy
authors.initials: Z
authors.lastname: Gutkovich
mesh_terms: D000284:Administration, Oral; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D002648:Child; D002673:Child, Hospitalized / Q000523:psychology*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007297:Inpatients; D008297:Male; D019999:Pharmaceutical Solutions / Q000008:administration & dosage; D011889:Rage / Q000187:drug effects*; D018967:Risperidone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D012890:Sleep / Q000187:drug effects; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents; D019999:Pharmaceutical Solutions; D018967:Risperidone
references.citation: J Am Acad Child Adolesc Psychiatry. 2007 Jan;46(1):107-125
references.pmid: 17195735
references.citation: Am J Psychiatry. 1994 Jul;151(7):1043-7
references.pmid: 8010362
references.citation: Curr Psychiatry Rep. 2009 Apr;11(2):127-33
references.pmid: 19302766
references.citation: N Engl J Med. 2002 Aug 1;347(5):314-21
references.pmid: 12151468
references.citation: J Am Acad Child Adolesc Psychiatry. 1991 Jul;30(4):669-73
references.pmid: 1890103
references.citation: J Am Acad Child Adolesc Psychiatry. 2002 Feb;41(2 Suppl):4S-25S
references.pmid: 11833634
references.citation: Biol Psychiatry. 2005 Oct 1;58(7):583-8
references.pmid: 16197929
references.citation: Arch Gen Psychiatry. 1982 Aug;39(8):879-83
references.pmid: 7103676
references.citation: J Clin Child Adolesc Psychol. 2002 Dec;31(4):513-24
references.pmid: 12402570
references.citation: J Am Acad Child Adolesc Psychiatry. 2007 Mar;46(3):309-322
references.pmid: 17314717
references.citation: Biol Psychiatry. 2005 Oct 1;58(7):576-82
references.pmid: 16084859
references.citation: J Child Adolesc Psychopharmacol. 2007 Aug;17(4):503-9
references.pmid: 17822344
references.citation: Acta Psychiatr Scand Suppl. 1970;212:11-9
references.pmid: 4917967
references.citation: Am J Psychiatry. 2003 Mar;160(3):430-7
references.pmid: 12611821
references.citation: J Am Acad Child Adolesc Psychiatry. 1998 Feb;37(2):228-30
references.pmid: 9473921
references.citation: Br J Psychiatry. 1989 May;154:672-6
references.pmid: 2574607
references.citation: J Clin Psychiatry. 1991 Dec;52(12):499-501
references.pmid: 1752851
references.citation: Am J Psychiatry. 2009 Jan;166(1):18-24
references.pmid: 19122014
references.citation: J Child Adolesc Psychopharmacol. 2009 Feb;19(1):61-73
references.pmid: 19232024
references.citation: Am J Psychiatry. 2002 Aug;159(8):1337-46
references.pmid: 12153826
references.citation: J Am Acad Child Adolesc Psychiatry. 2007 Jul;46(7):894-921
references.pmid: 17581453
references.citation: J Child Adolesc Psychopharmacol. 2006 Dec;16(6):671-7
references.pmid: 17201611
references.citation: Arch Gen Psychiatry. 2006 Feb;63(2):175-83
references.pmid: 16461861
references.citation: J Child Adolesc Psychopharmacol. 2009 Jun;19(3):281-8
references.pmid: 19519263
references.citation: J Clin Psychiatry. 2001 Mar;62(3):153-7
references.pmid: 11305699