A 12-year-old Hindu boy studying in the sixth standard was brought by his mother to the child guidance clinic of our hospital with chief complaints of getting angry easily, irritability, conduct issues in school like getting into fights and back answering the teachers, decreased academic performance over the last 2 years and aggressive behavior at home toward the younger sister who was 8 years old. The boy was apparently alright until 2 years ago when he developed a friendship with a group of boys in school who exhibited mischief, truancy, and bad behavior. Gradually, he developed these behavior resulting in getting punished and having multiple negative remarks in his school calendar. He had physical fights with other students in school and had even injured other students such that they had bleeding after the injury. The school decided that his aggression was excessive and advised him to visit a psychiatrist for an evaluation. He was reluctant to come and was brought forcibly by his mother for a consultation.
On detailed assessment, the boy had a normal birth and developmental history. He had a history suggestive of attention deficit hyperactivity disorder in childhood (up to the age of 8 years) which subsided as they had enrolled him into sports like football and he also underwent regular occupational therapy sessions. There was no history suggestive of any other psychiatric disorders in the child or that of epilepsy or head injury. The parents were well adjusted, and the family too did not have any interpersonal problems. The child admitted that he got aggressive and that though he would regret it later, it was difficult for him to control his aggression whenever it happened. The mother was psychoeducated about the problem and was suggested certain behavior therapy techniques like positive and negative reinforcement that would work overtime. She was educated about medical intervention for anger and conduct problems and agreed to the same. She was told to ensure regular follow-up when on the medication. The child was started on Risperidone 0.5 mg half a tablet t.i.d. (total dose 0.75 mg per day). The dose would later be increased week by week after evaluation. Within a week of starting the medication at 0.75 mg per day, the mother complained that her child starting passing urine in bed at night during his sleep. The mother ensured that the child went to the toilet before sleeping and was alarmed he never had enuresis in the past, and this was the first time ever that such symptoms appeared. She claimed that the enuresis had started within 2 days of starting Risperidone. We stopped Risperidone and decided to withhold medications for a week. Within 2 days of stopping Risperidone, the enuresis stopped. We started Risperidone in the same dose after a week of no enuresis and the very same night; the child had enuresis. Risperidone was then replaced with aripiprazole 5 mg per day, and the child is doing fine till date.