Retrospective Analysis of Risperidone and Methylphenidate Use in Preschool Age According to the Drug Benefit and Side Effects

Öz

Objective: Although there is increasing number of psychopharmacological treatments in preschoolers, there is still limited information in literature about the efficacy and safety of the drugs. In this study, we aimed to investigate the efficacy, doses, side effects and the variables that predict the clinical benefit of the most used drugs(methylphenidate and risperidone) in our clinic from preschoolers.

Material and Methods: The patient records in our clinic, whose medication was started between 0-6 years old were scanned retrospectively. Fifty children using methylphenidate and 45 children using risperidone were evaluated with scored Clinical Global Impression Scale (CGI) and Global Assessment of Functioning Scale (GAS). Patients using methylphenidate and risperidone were compared in their own group and with each other concerning the parameters investigated.

Results: There was a statistifically significant difference between before and after drug assessments of the patients according to symptom severity(CGI-S scores) and clinical functionality (GAS scores). The age, gender, presence of preschool education, prenatal—natal-postnatal problem or medical disease history had no significant relationship with the efficacy or side effects of the drugs. None of the medication investigated were found superior to other concerning the efficacy and side effect profiles.

Conclusion: Methylphenidate and risperidone were found effective and safe among the drugs recommended for the pharmacological treatment of behaviour problems, hyperactivity and irritability in the preschool age. Further prospective studies in larger clinical samples with longer follow-up periods are needed to draw certain conclusions about the psychopharmacological treatments in preschoolers.

Anahtar Kelimeler

• preschool
• methylphenidate
• risperidone

Okul Öncesi Dönemde Psikiyatrik İlaç Tedavisi Başlanan Hastaların İlaç Tedavisinden Fayda Görmeleri ve Yan Etkiler Açısından Retrospektif Taranması

Öz

Amaç: Okul öncesi yaş grubundaki çocuklarda psikiyatrik bozukluklar için giderek artan düzeyde ilaç tedavisi uygulanmasına rağmen, bu yaş grubundaki çocuklarda psikiyatrik ilaç yararlanımına, ilaç yan etkilerine ilişkin yeterli sayıda araştırma yoktur. Çalışmamızda bu yaş grubunda kliniğimizde değerlendirilen hastaların kayıtlarının, en sık kullanılan metilfenidat ve risperidon ilaç tedavilerinin yararlanımları, dozları, yan etkileri ve tedaviye yanıt üzerinde etkisi olabileceği düşünülen eşlik eden özellikler açısından araştırılması hedeflenmiştir.

Gereç ve Yöntemler: Bu amaçla, kliniğimizde 0-6 yaş aralığındaki ilaç tedavisi başlanan hastaların retrospektif muayane kayıtları incelenmiştir. 45 risperidon ve 50 metilfenidat kullanan hastanın ilaç yararlanımı, Klinik Global İzlenim (KGİ) ve Global Değerlendirme Ölçeği (GDÖ) ölçekleri skorlanarak belirlenmiştir. Risperidon ve metilfenidat kullanan hastalar araştırılan parametreler açısından kendi grupları içinde ve her iki grup biribiriyle karşılaştırılmıştır.

Bulgular: Risperidon ve metilfenidat kullanan hastaların ilaç tedavisi öncesi ve sonrası değerlendirmeleri arasında semptom şiddeti (KGİ-Ş skorlarındaki azalma) ve işlevsellik düzeyi (GDÖ skorlarındaki artış) açısından anlamlı düzelme bulunmuştur. Her iki grupta tedaviye yanıt üzerinde etkisi olabileceği düşünülen eşlik eden yaş, cinsiyet, okul öncesi eğitim alma, prenatal-natal-postnatal sorun, tıbbi hastalık gibi etkenlerin ilaçtan yararlanım ve yan etki açısından anlamlı bir ilişki bulunmamıştır.

Sonuç: Okul öncesi yaş grubunda davranış sorunları, hiperaktivite, irritabilite tedavisi için önerilen ilaç tedavilerinden metilfenidat ve risperidon faydalı ve güvenilir bulunmuştur. Bu yaş grubunda psikofarmakolojik tedaviler ile ilgili daha net sonuçlara ulaşabilmek için, geniş örneklemli ve uzun süre izlem içeren, prospektif çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

• metilfenidat
• okul öncesi
• risperidon

Kaynakça

1. Referans 1. Arabgol F, Panaghi L, Nikzad V. Risperidone Versus Methylphenidate in Treatment of Preschool Children With Attention-Deficit Hyperactivity Disorder. Iran J Pediatr 2015; 25:e265
2. Referans 2. Tandon M, Si X, Luby J. Preschool onset attention-deficit/hyperactivity disorder: course and predictors of stability over 24 months. J Child Adolesc Psychopharmacol 2011; 21:321-30
3. Referans 3. Uygun SD GZ, Acikel SB, Dinc G, Hekim O, Cop E, Uneri OS. Psychotropic Drug Use in Preschool and Toddler Age Groups: An Evaluation of Hospital Admissions. Psychiatry and Behavioral Sciences 2019; 9(3):112-118.
4. Referans 4. Egger HL, Angold A. Common emotional and behavioral disorders in preschool children: presentation, nosology, and epidemiology. J Child Psychol Psychiatry 2006; 47:313-37
5. Referans 5. Wichstrom L, Berg-Nielsen TS, Angold A, Egger HL, Solheim E, Sveen TH. Prevalence of psychiatric disorders in preschoolers. J Child Psychol Psychiatry 2012; 53:695-705
6. Referans 6. Fanton J, Gleason MM. Psychopharmacology and preschoolers: a critical review of current conditions. Child Adolesc Psychiatr Clin N Am 2009; 18:753-71
7. Referans 7. Taş FV ÖA, Janbakhishov CE, Karaarslan D. . Bir üniversite kliniği deneyimi: erken çocukluk döneminde psikotrop ilaç kullanımı. Çocuk ve Gençlik Ruh Sağlığı Dergisi 2015; 22 (1): 17-27
8. Referans 8. Connor DF. Preschool attention deficit hyperactivity disorder: a review of prevalence, diagnosis, neurobiology, and stimulant treatment. J Dev Behav Pediatr 2002; 23:S1-9

9. Referans 9. Boyle CA, Boulet S, Schieve LA, Cohen RA, Blumberg SJ, Yeargin-Allsopp M, et al. Trends in the prevalence of developmental disabilities in US children, 1997-2008. Pediatrics 2011; 127:1034-42
10. Referans 10. Gleason MM, Egger HL, Emslie GJ, Greenhill LL, Kowatch RA, Lieberman AF, et al. Psychopharmacological treatment for very young children: contexts and guidelines. J Am Acad Child Adolesc Psychiatry 2007; 46:1532-72
11. Referans 11. Spetie L, Arnold LE: Attention-Deficit/Hyperactivity Disorder; in: Andres M, Volkmar FR (eds): Lewis's Child and Adolescent Psychiatry: A Comprehensive Textbook 4th Edition. USA Lippincott Williams & Wilkins 2007, pp 431-454
12. Referans 12. Safavi P, Dehkordi AH, Ghasemi N. Comparison of the effects of methylphenidate and the combination of methylphenidate and risperidone in preschool children with attention-deficit hyperactivity disorder. J Adv Pharm Technol Res 2016; 7:144-8
13. Referans 13. Coskun M ZSS, Ozturk M. Risperidone Treatment in Preschool Children with Disruptive Behavior Disorders: A Chart Review Study. Klinik Psikofarmakoloji Bülteni-Bulletin of Clinical Psychopharmacology 2011; 21:1, 33-4
14. Referans 14. Fuentes-Biggi J, Ferrari-Arroyo MJ, Boada-Munoz L, Tourino-Aguilera E, Artigas-Pallares J, Belinchon-Carmona M, et al. [Good practice guidelines for the treatment of autistic spectrum disorders]. Rev Neurol 2006; 43:425-38
15. Referans 15. Fung LK, Mahajan R, Nozzolillo A, Bernal P, Krasner A, Jo B, et al. Pharmacologic Treatment of Severe Irritability and Problem Behaviors in Autism: A Systematic Review and Meta-analysis. Pediatrics 2016; 137 Suppl 2:S124-35
16. Referans 16. Masi G, Cosenza A, Mucci M, De Vito G. Risperidone monotherapy in preschool children with pervasive developmental disorders. J Child Neurol 2001; 16:395-400
17. Referans 17. Hollingshead AB, Redlich FC. Social class and mental illness: a community study. 1958. Am J Public Health 2007; 97:1756-7
18. Referans 18. Guy W, editor. ECDEU Assessment Manual for Psychopharmacology. Rockville, MD: US Department of Heath, Education, and Welfare Public Health Service Alcohol, Drug Abuse, and Mental Health Administration, 1976: 76-338.
19. Referans 19. Busner J, Targum SD. The clinical global impressions scale: applying a research tool in clinical practice. Psychiatry (Edgmont) 2007; 4:28-37
20. Referans 20. Endicott J, Spitzer RL, Fleiss JL, Cohen J. The global assessment scale. A procedure for measuring overall severity of psychiatric disturbance. Arch Gen Psychiatry 1976; 33:766-71
21. Referans 21. Aman MG. Treatment of Severe Childhood Aggression (TOSCA) Studies. J Child Adolesc Psychopharmacol 2015; 25:201-2
22. Referans 22. Aman MG, Arnold LE, McDougle CJ, Vitiello B, Scahill L, Davies M, et al. Acute and long-term safety and tolerability of risperidone in children with autism. J Child Adolesc Psychopharmacol 2005; 15:869-84
23. Referans 23. Herguner S, Mukaddes NM. Risperidone-induced enuresis in two children with autistic disorder. J Child Adolesc Psychopharmacol 2007; 17:527-30
24. Referans 24. Sultan RS, Wang S, Crystal S, Olfson M. Antipsychotic Treatment Among Youths With Attention-Deficit/Hyperactivity Disorder. JAMA Netw Open 2019; 2:e197850
25. Referans 25. Chung J, Tchaconas A, Meryash D, Adesman A. Treatment of Attention-Deficit/Hyperactivity Disorder in Preschool-Age Children: Child and Adolescent Psychiatrists' Adherence to Clinical Practice Guidelines. J Child Adolesc Psychopharmacol 2016; 26:335-43
26. Referans 26. Greenhill L, Kollins S, Abikoff H, McCracken J, Riddle M, Swanson J, et al. Efficacy and safety of immediate-release methylphenidate treatment for preschoolers with ADHD. J Am Acad Child Adolesc Psychiatry 2006; 45:1284-93
27. Referans 27. Wigal T, Greenhill L, Chuang S, Mc GJ, Vitiello B, Skrobala A, et al. Safety and tolerability of methylphenidate in preschool children with ADHD. J Am Acad Child Adolesc Psychiatry 2006; 45:1294-303
28. Referans 28. van der Veen-Mulders L, van den Hoofdakker BJ, Nauta MH, Emmelkamp P, Hoekstra PJ. Methylphenidate Has Superior Efficacy Over Parent-Child Interaction Therapy for Preschool Children with Disruptive Behaviors. J Child Adolesc Psychopharmacol 2018; 28:66-73
29. Referans 29. Hoekstra PJ. Looking beyond randomized controlled trials. Eur Child Adolesc Psychiatry 2017; 26:385-6
30. Referans 30. Adjei AL, Chaudhary I, Kollins SH, Padilla A. A Pharmacokinetic Study of Methylphenidate Hydrochloride Multilayer Extended-Release Capsules (Aptensio XR((R))) in Preschool-Aged Children with Attention-Deficit/Hyperactivity Disorder. Paediatr Drugs 2020; 22:561-70
31. Referans 31. Handen BL, Feldman HM, Lurier A, Murray PJ. Efficacy of methylphenidate among preschool children with developmental disabilities and ADHD. J Am Acad Child Adolesc Psychiatry 1999; 38:805-12
32. Referans 32. Sturman N, Deckx L, van Driel ML. Methylphenidate for children and adolescents with autism spectrum disorder. Cochrane Database Syst Rev 2017; 11:CD011144