H Javelot1, C Glay-Ribau2, F Ligier3, L Weiner4, N Didelot5, M Messaoudi6, M Socha7, F Body-Lawson3, B Kabuth8. 1. Centre psychothérapeutique de Nancy-Laxou, 54520 Laxou, France; Service de psychiatrie de l'enfant et de l'adolescent, hôpital d'enfants, 54500 Vandœuvre-lès-Nancy, France; ETAP - neuropsychopharmacology department, 54500 Vandœuvre-lès-Nancy, France; Psychiatry II and Inserm unit 1114, university hospital of Strasbourg, 67000 Strasbourg, France; Clinical pharmacy service, établissement public de santé Alsace Nord, 67170 Brumath, France. Electronic address: herve.javelot@ch-epsan.fr. 2. Centre psychothérapeutique de Nancy-Laxou, 54520 Laxou, France. 3. Service de psychiatrie de l'enfant et de l'adolescent, hôpital d'enfants, 54500 Vandœuvre-lès-Nancy, France. 4. Psychiatry II and Inserm unit 1114, university hospital of Strasbourg, 67000 Strasbourg, France. 5. Centre sanitaire les Rives du Château, Croix Rouge française, 54450 Blâmont, France. 6. ETAP - neuropsychopharmacology department, 54500 Vandœuvre-lès-Nancy, France. 7. Service pharmacie, hôpital Brabois-Adultes, CHU de Nancy, 54500 Vandœuvre-lès-Nancy, France. 8. Centre psychothérapeutique de Nancy-Laxou, 54520 Laxou, France; Service de psychiatrie de l'enfant et de l'adolescent, hôpital d'enfants, 54500 Vandœuvre-lès-Nancy, France.
Abstract
INTRODUCTION: Psychotimulant-antipyschotic combinations are frequently used in child psychiatry, but have been rarely described in the literature. METHOD AND PATIENTS: We propose here a retrospective study of 44 children who received the combination methylphenidate (MPH)-risperidone (RIS). The sample is composed of children who received either MPH (n=28) or RIS (n=16) as primary treatment. A vast majority of the children had a comorbid attention deficit hyperactivity disorder (ADHD) diagnosis. RESULTS: For over 60% of patients, regardless of their initial monotherapy, bitherapy decreased the symptoms of ADHD and conduct disorder, sleep disorders and anxiety. Concerning the safety of the bitherapy, a compensation effect on weight gain and appetite was respectively observed in 70% and 50% of patients. Even though iatrogenic tachycardia can be encountered with both drugs, it has never been reported when they are associated and we have reported a total of 3 cases in our study. We have also observed a case of dyskinesia resolved with the discontinuation of the treatment. DISCUSSION/ CONCLUSION: MPH-RIS bitherapy appears to be particularly effective in ADHD with conduct disorder symptoms. Although tolerance may limit its use, the benefit/risk ratio seems favourable for a number of children.
INTRODUCTION: Psychotimulant-antipyschotic combinations are frequently used in child psychiatry, but have been rarely described in the literature. METHOD AND PATIENTS: We propose here a retrospective study of 44 children who received the combination methylphenidate (MPH)-risperidone (RIS). The sample is composed of children who received either MPH (n=28) or RIS (n=16) as primary treatment. A vast majority of the children had a comorbid attention deficit hyperactivity disorder (ADHD) diagnosis. RESULTS: For over 60% of patients, regardless of their initial monotherapy, bitherapy decreased the symptoms of ADHD and conduct disorder, sleep disorders and anxiety. Concerning the safety of the bitherapy, a compensation effect on weight gain and appetite was respectively observed in 70% and 50% of patients. Even though iatrogenic tachycardia can be encountered with both drugs, it has never been reported when they are associated and we have reported a total of 3 cases in our study. We have also observed a case of dyskinesia resolved with the discontinuation of the treatment. DISCUSSION/ CONCLUSION:MPH-RIS bitherapy appears to be particularly effective in ADHD with conduct disorder symptoms. Although tolerance may limit its use, the benefit/risk ratio seems favourable for a number of children.