Risperidone treatment of autistic disorder: longer-term benefits and blinded discontinuation after 6 months
Child; Female; Humans; Male; Treatment Outcome; Longitudinal Studies; Personality Inventory; Drug Administration Schedule; adolescent; Preschool; Psychiatric Status Rating Scales; Antipsychotic Agents/adverse effects/therapeutic use; Placebos; Risperidone/adverse effects/therapeutic use; Aggression/drug effects/psychology; Autistic Disorder/diagnosis/drug therapy/psychology; Child Behavior Disorders/diagnosis/drug therapy/psychology; Self-Injurious Behavior/diagnosis/drug therapy/psychology; Substance Withdrawal Syndrome/diagnosis/psychology
OBJECTIVE: Risperidone is effective for short-term treatment of aggression, temper outbursts, and self-injurious behavior in children with autism. Because these behaviors may be chronic, there is a need to establish the efficacy and safety of longer-term treatment with this agent. METHOD: The authors conducted a multisite, two-part study of risperidone in children ages 5 to 17 years with autism accompanied by severe tantrums, aggression, and/or self-injurious behavior who showed a positive response in an earlier 8-week trial. Part I consisted of 4-month open-label treatment with risperidone, starting at the established optimal dose; part II was an 8-week randomized, double-blind, placebo-substitution study of risperidone withdrawal. Primary outcome measures were the Aberrant Behavior Checklist irritability subscale and the Clinical Global Impression improvement scale. RESULTS: Part I included 63 children. The mean risperidone dose was 1.96 mg/day at entry and remained stable over 16 weeks of open treatment. The change on the Aberrant Behavior Checklist irritability subscale was small and clinically insignificant. Reasons for discontinuation of part I included loss of efficacy (N=5) and adverse effects (N=1). The subjects gained an average of 5.1 kg. Part II included 32 patients. The relapse rates were 62.5% for gradual placebo substitution and 12.5% for continued risperidone; this difference was statistically significant. CONCLUSIONS: Risperidone showed persistent efficacy and good tolerability for intermediate-length treatment of children with autism characterized by tantrums, aggression, and/or self-injurious behavior. Discontinuation after 6 months was associated with a rapid return of disruptive and aggressive behavior in most subjects.
2005
Autism Network Research Units on Pediatric Psychopharmacology
The American Journal Of Psychiatry
2005
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1176/appi.ajp.162.7.1361" target="_blank" rel="noreferrer">10.1176/appi.ajp.162.7.1361</a>
Family focused grief therapy: a randomized, controlled trial in palliative care and bereavement
Female; Humans; Male; Grief; Palliative Care; Terminal Care; Adult; Follow-Up Studies; Middle Aged; Family Relations; Treatment Outcome; Longitudinal Studies; Social Adjustment; Family Health; Personality Inventory; Stress; bereavement; Caregivers/psychology; Family/psychology; SSHRC CURA; Family Therapy/methods; Depressive Disorder/therapy; Psychological/therapy
OBJECTIVE: The aim of family focused grief therapy is to reduce the morbid effects of grief among families at risk of poor psychosocial outcome. It commences during palliative care of terminally ill patients and continues into bereavement. The authors report a randomized, controlled trial. METHOD: Using the Family Relationships Index, the authors screened 257 families of patients dying from cancer: 183 (71%) were at risk, and 81 of those (44%) participated in the trial. They were randomly assigned (in a 2:1 ratio) to family focused grief therapy (53 families, 233 individuals) or a control condition (28 families, 130 individuals). Assessments occurred at baseline and 6 and 13 months after the patient's death. The primary outcome measures were the Brief Symptom Inventory, Beck Depression Inventory, and Social Adjustment Scale. The Family Assessment Device was a secondary outcome measure. Analyses allowed for correlated family data and employed generalized estimating equations based on intention to treat and controlling for site. RESULTS: The overall impact of family focused grief therapy was modest, with a reduction in distress at 13 months. Significant improvements in distress and depression occurred among individuals with high baseline scores on the Brief Symptom Inventory and Beck Depression Inventory. Global family functioning did not change. Sullen families and those with intermediate functioning tended to improve overall, whereas depression was unchanged in hostile families. CONCLUSIONS: Family focused grief therapy has the potential to prevent pathological grief. Benefit is clear for intermediate and sullen families. Care is needed to avoid increasing conflict in hostile families.
2006
Kissane DW; McKenzie M; Bloch S; Moskowitz C; McKenzie DP; O'Neill I
The American Journal Of Psychiatry
2006
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1176/appi.ajp.163.7.1208" target="_blank" rel="noreferrer">10.1176/appi.ajp.163.7.1208</a>
Continuity of care: an approach to measurement
Hospitalization; Humans; Questionnaires; Follow-Up Studies; Prospective Studies; Communication; Psychotherapy; Comprehensive Health Care; Medical Records; Ambulatory Care; Models; referral and consultation; Theoretical; Community Mental Health Services; Evaluation Studies as Topic; Community Psychiatry; Day Care; Mental Disorders/therapy; Transfer Agreement
1972
Bass RD; Windle C
The American Journal Of Psychiatry
1972
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1176/ajp.129.2.196" target="_blank" rel="noreferrer">10.1176/ajp.129.2.196</a>