Risperidone is an antipsychotic medication that is commonly used to manage aggression or agitation induced by psychosis. However, it is unclear whether risperidone can effectively calm a person down. In fact, according to a review of nine randomized controlled trials conducted by the Cochrane Schizophrenia Group, the evidence for the effectiveness of risperidone in rapidly tranquilizing individuals with psychosis-induced aggression is of very low quality.
The Trials
The nine trials examined in the Cochrane review were small and under-sampled, with a total of 582 participants. The trials compared the rapid use of risperidone with other drugs, combinations of drugs, or placebo for individuals exhibiting aggression or agitation (or both) thought to be due to psychosis.
The Outcomes
The main outcomes examined in the trials were agitation or aggression, the need for restraint, and the incidence of adverse effects. None of the included studies provided usable data on the primary outcome of tranquilization or sleep by 30 minutes, repeated need for tranquilization, or any economic outcomes.
Risperidone Versus Other Drugs
The Cochrane review found no clear difference between risperidone and haloperidol in terms of efficacy for the outcome of specific behavior – agitation, measured as at least a 50% reduction in the Positive and Negative Syndrome Scale – Psychotic Agitation Sub-score (PANSS-PAS) or for the need to use restraints. Similarly, no effect was observed for agitation measured as PANSS-PAS endpoint score at two hours for the comparison of risperidone versus olanzapine.
For the comparison of risperidone versus quetiapine, aggression was measured using the Modified Overt Aggression Scale (MOAS) endpoint score at two weeks. A clear difference, favoring quetiapine, was observed. For the comparison of risperidone versus risperidone + oxcarbazepine, one trial found a clear difference favoring the combination treatment for agitation using the PANSS-EC endpoint score at one week. Finally, for the comparison of risperidone versus risperidone + valproic acid, no clear differences between the treatment groups were observed for aggression or the incidence of akathisia after 24 hours.
Conclusion
In conclusion, while risperidone is commonly used to manage aggression or agitation induced by psychosis, the evidence for its effectiveness in rapidly tranquilizing individuals with psychosis-induced aggression is of very low quality. The trials examined in the Cochrane review were small and under-sampled, and the outcomes measured were indirect and lacked pragmatic measures. Therefore, it is difficult to say with certainty whether risperidone can calm a person down. Further high-quality research is needed to determine the effectiveness of risperidone in managing aggression or agitation induced by psychosis.