Treating Aggression in Children and Teenagers

Introduction

To treat aggression in children and teenagers, it is possible to apply different types of antipsychotics. In order to address the condition in a 15-year-old healthy male individual, such medication as risperidone can be used (Mauri et al., 2014). The purpose of this paper is to discuss the appropriate dosage, administration, and side effects and focus on the concept of the off-label use of medications.

Administration and Mechanisms of Action

The recommended initial dose is 0.5 mg orally per day. The titration dose is 1 mg per day taken in 24 hours. The maintenance dose for the client is 2 mg per day. Risperidone should be administered with or without food once a day. Possible side effects include agitation, dizziness, constipation, nausea, and dystonia. The mechanism of action depends on the affinity for dopamine D2 receptors and serotonin 5HT2 and 5HT7 receptors (Mauri et al., 2014). There is also the affinity for α1 and α2 and histamine receptors. Risperidone is absorbed rapidly, it is metabolized through 9-hydroxylation in the liver, peak plasma concentrations are observed in an hour, and linear pharmacokinetics is typical. Concerning excretion, risperidone is mainly eliminated via the urine, and the half-life of it is 3 hours.

Side Effects

Potential side effects are anxiety, agitation, drowsiness, akathisia, possible changes in vision, and abdominal pain. The patient should be educated to report any of these conditions to a medical worker. Other adverse reactions are nausea, diarrhea, dystonia, tachycardia, concentration difficulties, sleepiness, and problems with urination (Mauri et al., 2014). To monitor these effects, patients should be informed about the probability of these conditions and contacting the physician when they are observed.

Definition of Off-Label Use of Medications

The off-label use of such a psychotropic medication as risperidone means the prescription of this drug for treating conditions that are not approved by the Food and Drug Administration (FDA). The use of risperidone for managing aggressive behaviors is off-label because the medication is approved only for treating schizophrenia, bipolar disorder, and autism (Carton et al., 2015). Thus, a physician takes full responsibility for prescribing a medication for a non-approved indication referring to available evidence.

Explanation to Parents

To explain the off-label use of risperidone to parents, it is necessary to refer to available evidence from trials on applying this drug for treating aggressive behaviors. A narrow range of medications is approved by the FDA for treating aggression in children and adolescents (Carton et al., 2015). The decision is made depending on evidence regarding the use of psychotropic drugs for managing this condition.

Sound Clinical Decisions and Conclusion

The off-label prescription of medications can be a sound clinical decision when there is clear evidence regarding their positive impact on treated conditions. This practice is typical of psychiatry, especially with reference to treating children and adolescents (Nielsen et al., 2016). Psychiatric classifications can unite spectrums of conditions of a similar clinical nature, and the off-label use of second-generation antipsychotics is possible. There can be no other alternatives available to address certain conditions.

References

Carton, L., Cottencin, O., Lapeyre-Mestre, M., Geoffroy, P., Favre, J., Simon, N.,… Rolland, B. (2015). Off-label prescribing of antipsychotics in adults, children and elderly individuals: A systematic review of recent prescription trends. Current Pharmaceutical Design, 21(23), 3280-3297.

Mauri, M. C., Paletta, S., Maffini, M., Colasanti, A., Dragogna, F., Di Pace, C., & Altamura, A. C. (2014). Clinical pharmacology of atypical antipsychotics: An update. EXCLI Journal, 13, 1163-1191.

Nielsen, E. S., Hellfritzsch, M., Sørensen, M. J., Rasmussen, H., Thomsen, P. H., & Laursen, T. (2016). Off-label prescribing of psychotropic drugs in a Danish child and adolescent psychiatric outpatient clinic. European Child & Adolescent Psychiatry, 25(1), 25-31.