Risperidone versus placebo for aggression following traumatic brain injury: a feasibility randomised controlled trial

Deb, Shoumitro ORCID logoORCID: https://orcid.org/0000-0002-1300-8103, Aimola, Lina, Leeson, Verity, Bodani, Mayur, Li, Lucia, Weaver, Tim ORCID logoORCID: https://orcid.org/0000-0002-3437-3556, Sharp, David, Bassett, Paul and Crawford, Mike (2020) Risperidone versus placebo for aggression following traumatic brain injury: a feasibility randomised controlled trial. BMJ Open, 10 (9) , e036300. pp. 1-12. ISSN 2044-6055 [Article] (doi:10.1136/bmjopen-2019-036300)

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Objectives: To conduct a feasibility randomised controlled trial of risperidone for the treatment of aggression in adults with traumatic brain injury (TBI).

Design: Multicentre, parallel design, placebo controlled (1:1 ratio) double-blind feasibility trial with an embedded process evaluation. No statistical comparison was performed between the two study groups.

Setting: Four neuropsychiatric and neurology outpatient clinics in London and Kent, UK.

Participants: Our aim was to recruit 50 patients with TBI over 18 months. Follow-up participants at 12 weeks using a battery of assessment scales to measure changes in aggressive behaviour and irritability (Modified Overt Aggression Scale (MOAS)-primary outcome, Irritability Questionnaire) as well as global functioning (Glasgow Outcome Scale-Extended, Clinical Global impression) and quality of life (EQ-5D-5L, SF-12), mental health (Hospital Anxiety and Depression Scale) and medication adverse effects (Udvalg for Kliniske Undersøgelser).

Results: Six participants were randomised to the active arm of the trial and eight to the placebo arm over a 10-month period (28% of our target). Two participants withdrew because of adverse events. Twelve out of 14 (85.7%) patients completed a follow-up assessment at 12 weeks. At follow-up, the scores of all outcome measures improved in both groups. Placebo group showed numerically better score change according to the primary outcome MOAS. No severe adverse events were reported. The overall rate of adverse events remained low. Data from the process evaluation suggest that existence of specialised TBI follow-up clinics, availability of a dedicated database of TBI patients’ clinical details, simple study procedures and regular support to participants would enhance recruitment and retention in the trial. Feedback from participants showed that once in the study, they did not find the trial procedure onerous.

Conclusions: It was not feasible to conduct a successful randomised trial of risperidone versus placebo for post-TBI aggression using the methods we deployed in this study. It is not possible to draw any definitive conclusion about risperidone’s efficacy from such a small trial. Trial registration number: ISRCTN30191436

Item Type: Article
Keywords (uncontrolled): Mental health, 1506, 1712, psychiatry, adult psychiatry, impulse control disorders
Research Areas: A. > School of Health and Education > Mental Health, Social Work and Interprofessional Learning
Item ID: 30971
Notes on copyright: © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.
This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
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Depositing User: Jisc Publications Router
Date Deposited: 15 Sep 2020 09:35
Last Modified: 06 Oct 2022 20:28
URI: https://eprints.mdx.ac.uk/id/eprint/30971

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