Efficacy of antipsychotics for irritability and aggression in children: a meta-analysis

ABSTRACT

Background: Aggression and irritability in children occur across a range of diagnoses, and are associated with both economic cost and negative psychosocial outcomes. Antipsychotics are frequently prescribed in these cases.

Methods: A random effects meta-analysis of 14 random controlled trials was conducted. Overall effect sizes for antipsychotics for irritability and aggression were extracted. Subgroup analyses were conducted according to diagnostic indication, specific medication and degree of sedation. Meta-regression examined effects of antipsychotic dose.

Results: Overall, antipsychotics were effective in reducing aggression and irritability (SMD = 0.74, 95% confidence interval [CI] 0.57–0.92, z = 8.4, p < 0.0001). In stratified subgroup analysis, individual antipsychotic agents did not differ in efficacy (χ² = 1.1, df = 3, p = 0.78). However, aripiprazole and risperidone demonstrated significant benefit over placebo. Antipsychotic efficacy did not differ significantly based on diagnostic indication (χ² = 4.2, df = 4, p = 0.39). Meta-regression showed no overall dose effect.

Conclusions: Clinical data supports the efficacy of risperidone and aripiprazole for aggression and irritability across diagnoses, with insufficient data available for other agents. Available data does not support a difference in efficacy based on underlying diagnosis, choice of agent, or its degree of sedation.

KEYWORDS:

• Adolescents
• aggression
• antipsychotics
• children
• irritability

Declaration of interest

G van Schalkwyk has been supported by the Yale Child Study Center Associates. C Beyer acknowledges support from the Yale Child Study Center Associates and the Taylor Foundation. MH Block has received support from the National Institutes of Health (K23MH091240, R25MH077823), the Tourette Syndrome Association, Biohaven Pharmaceuticals, and Therapix Biosciences. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This paper was not funded.