Psychopharmacology includes both medications for mental illness and drugs of abuse. Both medications and drugs affect an individual’s ability to focus, their behavior, affect and cognition. For this reason, it is imperative that a counselor has extensive general knowledge about the history, dosages, physical and cognitive effects of both medications and drugs. One of the most prescribed antipsychotics in today’s society is Risperdal (History of Risperdal, 2014) data). Risperidone is classified as one of the most commonly prescribed atypical antipsychotics in the United States. While there has been debate and legal action taken surrounding what exactly risperidone is approved for, it has been used in the treatment of schizophrenia, and mania in bipolar disorder (Davis & Chen, 2002). Risperidone is also known to be useful in the treatment of psychosis, schizoaffective disorder, psychosis secondary to medical conditions, and depression with psychotic features (Jesner, Arif-Adib, & Coren 2007). While the span of treatment is vast, the one thing which stands out about this medication is that it has been advertised to be useful for a range of ages. Risperidone has medication has been used for children, adolescents, adults, and the elderly in the past. Usually, medications are used for a specific age range, but the ability of this medication to be used with many individuals is the significant factor in how it gained its popularity.
I. Basic Information
Risperidone is the first antipsychotic marketed in the United States since clozapine (Umbricht & Kane, 1995). Risperidone is the brand name of the medication is sold under the generic name of Risperdal. The forms of the medication which are currently available on the market are Risperdal, Risperdal M-tab, and Risperdal Consta. The medication is mainly used to treat Schizophrenia, Bipolar Disorder, and anger with Autism. Although there have been claims that this medication can help with diagnoses such as Mania, Tourette syndrome, Oppositional Defiant Disorder, and Delirium, there has not been research on the efficacy of its use concerning these treatments. The medication is considered to be a Serotonin-Dopamine Antagonist (SDA), an atypical antipsychotic. Risperdal is a second-generation antipsychotic which was developed by Janssen Pharmaceutica Inc., a division of Johnson & Johnson (J&J). Antipsychotic drugs have been used as a treatment for maladaptive behaviors since the 1950s, when first generation, also known as typical antipsychotic drugs, were first prescribed to children and young adults (Ben Amor, 2012). Some examples of typical antipsychotic drugs include haloperidol and clozapine.
The United States Drug Enforcement Administration (DEA) created a system to monitor and warn for controlled substances. The drug schedules are classified as I through V to serve as a classification system for all classes of drugs. This includes both licit and illicit substances. The schedules outlined are organized on a scale of most dangerous to lowest abuse potential. The schedules also include the ability of each drug to be used for medical purposes. Risperdal is not a controlled substance but does have a severe black box warning. The black box warning on prescribing information for Risperdal was required by the FDA to be added in 2006. The warning was placed after a review of 17 placebo-controlled studies with 5,106 elderly patients on antipsychotics over a period of about ten weeks (Kales, Kim, Zivin, Valenstein, Seyfried, Chiang, & Cunningham, 2012). Study results showed that elderly patients who took Risperdal had a risk of death that was 1.7 times higher than those who took a placebo. The specific causes of death varied from patient to patient but were primarily related to cardiovascular causes such as heart failure or heart attack and infections such as pneumonia.
The black box warning on Risperdal outlines the increased risk of death in elderly patients with dementia and states that Risperdal is not approved to treat these patients. Risperdal’s black box warning states:
“WARNING: INCREASED MORTALITY IN ELDERLY PATIENTS WITH DEMENTIA-RELATED PSYCHOSIS: Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. Risperdal is not approved for use in patients with dementia-related psychosis” (Kales et al., 2012).