Treatment of aggression with risperidone in children and adolescents with bipolar disorder: a case series


  • KC receives research support from the National Institute of Mental Health, The Heinz C. Prechter Foundation, The National Alliance for Research in Schizophrenia and Depression, The Klingenstein Third Generation Foundation, Abbott Laboratories and GlaxoSmithKline; consultant for Abbott Laboratories, AstraZeneca, GlaxoSmithKline, Janssen Pharmaceutica and Shire US; and serves on the speakers bureau for Abbott Laboratories, AstraZeneca, Eli Lilly & Co., GlaxoSmithKline and Ortho-McNeil. HS has received unrestricted educational grants from Abbott Laboratories, Forest, GlaxoSmithKline, Janssen, McNeil-Alza, Novartis, Pfizer, Solvay, Wyeth-Ayerst, Ortho-McNeil and Eli Lilly & Co.; research grants from NIJ, TCWF, Eucalyptus, Abbott Laboratories, Janssen and Pfizer; is an advisor/consultant for Abbott Laboratories and Janssen; and serves on the speakers bureau for Abbott Laboratories, AstraZenenca, Janssen and Eli Lilly & Co. KS has no reported conflict of interest.

Kirti Saxena, MD, Child/Adolescent Psychiatry Fellow, Department of Psychiatry, Division of Child/Adolescent Psychiatry, Stanford University, 401 Quarry Road, Palo Alto, CA 94305, USA. Fax: 650-723-5531; e-mail:


Objectives:  To evaluate the effectiveness and safety of risperidone in children and adolescents with bipolar disorder characterized by aggression and mania, despite treatment with mood stabilizers.

Methods:  A retrospective chart review of patients seen in an outpatient pediatric mood disorders clinic over an 18-month period was performed. Data were extracted from charts of patients who had a diagnosis of bipolar disorder with aggression that was uncontrolled on a mood stabilizer; as a result, these patients had risperidone added to their regimen.

Results:  Four boys (aged 7–15 years) and two girls (aged 8 and 14 years) were treated with risperidone (mean dosage, 0.85 mg/day) for 3–16 months. Aggressive behavior improved in all patients after risperidone was started and remained improved for the duration of follow-up. Other symptoms of mania also improved. Risperidone was generally well tolerated. Sedation and akathisia were reported in one patient.

Conclusions:  The addition of risperidone to a mood stabilizer may improve aggression and other symptoms of mania in pediatric patients with bipolar disorder who do not respond adequately to a mood stabilizer alone. The long-term efficacy and safety of this regimen should be evaluated in a controlled clinical trial.