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Greetings; this is David Rosenberg from the Psychopharmacology Institute. In this CAP—or Child and Adolescent Psychiatry—Smart Take, we aim to examine the role of risperidone in the treatment of children and adolescents diagnosed with anorexia nervosa. This area warrants attention; anorexia nervosa is the deadliest psychiatric disorder, with a mortality rate surpassing those of schizophrenia and other mental health conditions. This fact underscores the urgent need for improved treatment strategies. Alarmingly, there are currently no FDA-approved medications specifically for anorexia nervosa in youth—an issue that necessitates further research in order to manage this disorder better. Indeed, anorexia nervosa often proves challenging to treat, with relapse being more common than recovery. Early-onset anorexia nervosa may also have a bleak prognosis and outcome, substantiating the need for exploring alternative treatment options in this demographic.
This observational naturalistic study evaluated 120 patients diagnosed with anorexia nervosa—42 of whom were treated with risperidone over an average span of 116 days. The medication was generally well-tolerated; only 1 case reported nausea and asthenia. Unfortunately, despite its tolerability, the study’s results were disappointing. There were no significant differences between children and adolescents treated with risperidone vs those who were untreated in terms of admission or discharge rates, improvements in body mass index, or any psychopathology measures. The patient retention rate for risperidone after 3 months was 50%; after 1 year, it dropped to 9.5%. The drug was primarily discontinued due to the resolution of target symptoms. However, rehospitalization rates at 12 months were comparable between children and adolescents who were treated with risperidone and those who were not.
Despite these outcomes, it is noteworthy that this is the most extensive sample size covered in the existing literature, highlighting the need for longitudinal assessments and studies to evaluate long-term prognostic factors and tolerability. Furthermore, a comparison with broader samples is necessary; only 42 patients in this study received risperidone treatment. Other variables—such as additional treatments and behavioral therapies, comorbidities, duration of illness, the onset of illness, associated physical conditions, and illness severity—must also be considered. Although this study emphasizes risperidone’s tolerability, it fails to confirm its efficacy, raising more questions than answers.
The study is the first to assess the use of risperidone in hospitalized children and adolescents suffering from anorexia nervosa. It also prompts queries about the actual efficacy of risperidone—a drug commonly employed for various conditions, including eating disorders, in child and adolescent psychiatry. The anorexia nervosa subtype is particularly intriguing given that atypical antipsychotics like risperidone frequently result in significant weight gain—a side effect generally avoided but potentially beneficial for anorexia nervosa patients. Nevertheless, it is crucial to remember that second-generation antipsychotics are associated with carbohydrate metabolic abnormalities; although weight gain might benefit anorexia nervosa patients, exposing them to a heightened risk of metabolic syndromes, carbohydrate abnormalities, or diabetes would be detrimental.
In conclusion, although risperidone appears relatively safe and well-tolerated in children and adolescents diagnosed with anorexia nervosa—as per this particular study—it does not demonstrate any significant difference or improvement in weight gain, psychopathology measures, or rehospitalization rates. Consequently, recommending risperidone as a potent or effective medication for this population remains questionable unless future longitudinal and prospective studies successfully identify subpopulations or potential predictors of treatment response (or lack thereof) and long-term safety analysis alongside the risk of other side effects associated with these medications—particularly metabolic abnormalities.
Abstract
The Role of Risperidone in the Treatment of Children and Adolescents With Anorexia Nervosa
Jacopo Pruccoli, Luca Bergonzini, Ilaria Pettenuzzo, Antonia Parmeggiani
Background: Current Diagnostic and Statistical Manual of Mental Disorders (DSM)-5-based research provides limited data on the use of risperidone on children and adolescents with anorexia nervosa (AN) mainly in small-sample/case report studies.
Aim: To report the use of risperidone in a group of children and adolescents with feeding and eating disorders, specifically with AN.
Methods: Observational, naturalistic study. Psychopathology was assessed with Eating Disorders Inventory-3, Beck’s Depression Inventory-II, and Symptom Checklist-90-R. Data were reported for the whole sample, for patients treated with risperidone, and finally compared between patients with AN treated with risperidone and those receiving no atypical antipsychotics. Potential differences in admission-discharge changes in body mass index (BMI) and psychopathology were assessed with analyses of covariance corrected for baseline measures. Kaplan-Meier analyses were conducted to assess retention rates of risperidone (at 3 months and 1 year) and rates of rehospitalization on 1-year follow-up.
Results: The study enrolled 120 patients with AN (42 treated with risperidone). Risperidone was used for 116.7 (±122.8) days (total exposure = 3979 days) and well-tolerated (nausea, asthenia in one case). No significantly different admission-discharge improvements for BMI or psychopathology were documented for patients treated with risperidone. Risperidone showed a 3-month retention rate of 50.0% (1 year: 9.5%) and was discontinued mainly for the resolution of target symptoms. Cumulative freedom from rehospitalization at 12 months was comparable for treated and untreated patients (hazard ratio = 1.088; Log-rank p = 0.908).
Conclusions: This study reports real-life evidence of the use of risperidone in AN children and adolescents in the widest described sample so far. Longitudinal research should assess long-term prognostic factors and tolerability.
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Reference
Pruccoli, J., Bergonzini, L., Pettenuzzo, I., & Parmeggiani, A. (2023). The role of risperidone in the treatment of children and adolescents with anorexia nervosa. Journal of Psychopharmacology, 37(6), 545-553.
