The Pharmacological Management of Oppositional Behaviour, Conduct Problems, and Aggression in Children and Adolescents With Attention-Deficit Hyperactivity Disorder, Oppositional Defiant Disorder, and Conduct Disorder: A Systematic Review and Meta-Analysis. Part 2: Antipsychotics and Traditional Mood Stabilizers
Identifieur interne : 000006 ( Canada/Analysis ); précédent : 000005; suivant : 000007The Pharmacological Management of Oppositional Behaviour, Conduct Problems, and Aggression in Children and Adolescents With Attention-Deficit Hyperactivity Disorder, Oppositional Defiant Disorder, and Conduct Disorder: A Systematic Review and Meta-Analysis. Part 2: Antipsychotics and Traditional Mood Stabilizers
Auteurs : Tamara Pringsheim [Canada] ; Lauren Hirsch [Canada] ; David Gardner ; Daniel A. Gorman [Canada]Source :
- Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie [ 0706-7437 ] ; 2015.
Abstract
Attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD) are among the most common psychiatric diagnoses in childhood. Aggression and conduct problems are a major source of disability and a risk factor for poor long-term outcomes.
We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) of antipsychotics, lithium, and anticonvulsants for aggression and conduct problems in youth with ADHD, ODD, and CD. Each medication was given an overall quality of evidence rating based on the Grading of Recommendations Assessment, Development and Evaluation approach.
Eleven RCTs of antipsychotics and 7 RCTs of lithium and anticonvulsants were included. There is moderate-quality evidence that risperidone has a moderate-to-large effect on conduct problems and aggression in youth with subaverage IQ and ODD, CD, or disruptive behaviour disorder not otherwise specified, with and without ADHD, and high-quality evidence that risperidone has a moderate effect on disruptive and aggressive behaviour in youth with average IQ and ODD or CD, with and without ADHD. Evidence supporting the use of haloperidol, thioridazine, quetiapine, and lithium in aggressive youth with CD is of low or very-low quality, and evidence supporting the use of divalproex in aggressive youth with ODD or CD is of low quality. There is very-low-quality evidence that carbamazepine is no different from placebo for the management of aggression in youth with CD.
With the exception of risperidone, the evidence to support the use of antipsychotics and mood stabilizers is of low quality.
Url:
PubMed: 25886656
PubMed Central: 4344947
Affiliations:
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PMC:4344947Le document en format XML
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Part 2: Antipsychotics and Traditional Mood Stabilizers</title><author><name sortKey="Pringsheim, Tamara" sort="Pringsheim, Tamara" uniqKey="Pringsheim T" first="Tamara" last="Pringsheim">Tamara Pringsheim</name><affiliation wicri:level="4"><nlm:aff id="af1-cjp-2015-vol60-february-52-61">Assistant Professor, Department of Clinical Neurosciences, Psychiatry, Community Health Sciences, and Pediatrics, University of Calgary, Calgary, Alberta; Neurologist, Director, Calgary Tourette and Paediatric Movement Disorders Clinic, Calgary, Alberta.</nlm:aff><orgName type="university">Université de Calgary</orgName><country>Canada</country><placeName><settlement type="city">Calgary</settlement><region type="state">Alberta</region></placeName></affiliation></author><author><name sortKey="Hirsch, Lauren" sort="Hirsch, Lauren" uniqKey="Hirsch L" first="Lauren" last="Hirsch">Lauren Hirsch</name><affiliation wicri:level="4"><nlm:aff id="af2-cjp-2015-vol60-february-52-61">Student, Community Health Sciences, University of Calgary, Calgary, Alberta.</nlm:aff><orgName type="university">Université de Calgary</orgName><country>Canada</country><placeName><settlement type="city">Calgary</settlement><region type="state">Alberta</region></placeName></affiliation></author><author><name sortKey="Gardner, David" sort="Gardner, David" uniqKey="Gardner D" first="David" last="Gardner">David Gardner</name><affiliation><nlm:aff id="af3-cjp-2015-vol60-february-52-61">Professor, Department of Psychiatry and Pharmacy, Dalhousie University, Halifax, Nova Scotia.</nlm:aff><wicri:noCountry code="subfield">Nova Scotia.</wicri:noCountry></affiliation></author><author><name sortKey="Gorman, Daniel A" sort="Gorman, Daniel A" uniqKey="Gorman D" first="Daniel A" last="Gorman">Daniel A. Gorman</name><affiliation wicri:level="4"><nlm:aff id="af4-cjp-2015-vol60-february-52-61">Assistant Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario.</nlm:aff><orgName type="university">Université de Toronto</orgName><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">25886656</idno><idno type="pmc">4344947</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4344947</idno><idno type="RBID">PMC:4344947</idno><date when="2015">2015</date><idno type="wicri:Area/Pmc/Corpus">000340</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000340</idno><idno type="wicri:Area/Pmc/Curation">000340</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000340</idno><idno type="wicri:Area/Pmc/Checkpoint">000029</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000029</idno><idno type="wicri:Area/Ncbi/Merge">000296</idno><idno type="wicri:Area/Ncbi/Curation">000296</idno><idno type="wicri:Area/Ncbi/Checkpoint">000296</idno><idno type="wicri:doubleKey">0706-7437:2015:Pringsheim T:the:pharmacological:management</idno><idno type="wicri:Area/Main/Merge">000044</idno><idno type="wicri:Area/Main/Curation">000044</idno><idno type="wicri:Area/Main/Exploration">000044</idno><idno type="wicri:Area/Canada/Extraction">000006</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">The Pharmacological Management of Oppositional Behaviour, Conduct Problems, and Aggression in Children and Adolescents With Attention-Deficit Hyperactivity Disorder, Oppositional Defiant Disorder, and Conduct Disorder: A Systematic Review and Meta-Analysis. Part 2: Antipsychotics and Traditional Mood Stabilizers</title><author><name sortKey="Pringsheim, Tamara" sort="Pringsheim, Tamara" uniqKey="Pringsheim T" first="Tamara" last="Pringsheim">Tamara Pringsheim</name><affiliation wicri:level="4"><nlm:aff id="af1-cjp-2015-vol60-february-52-61">Assistant Professor, Department of Clinical Neurosciences, Psychiatry, Community Health Sciences, and Pediatrics, University of Calgary, Calgary, Alberta; Neurologist, Director, Calgary Tourette and Paediatric Movement Disorders Clinic, Calgary, Alberta.</nlm:aff><orgName type="university">Université de Calgary</orgName><country>Canada</country><placeName><settlement type="city">Calgary</settlement><region type="state">Alberta</region></placeName></affiliation></author><author><name sortKey="Hirsch, Lauren" sort="Hirsch, Lauren" uniqKey="Hirsch L" first="Lauren" last="Hirsch">Lauren Hirsch</name><affiliation wicri:level="4"><nlm:aff id="af2-cjp-2015-vol60-february-52-61">Student, Community Health Sciences, University of Calgary, Calgary, Alberta.</nlm:aff><orgName type="university">Université de Calgary</orgName><country>Canada</country><placeName><settlement type="city">Calgary</settlement><region type="state">Alberta</region></placeName></affiliation></author><author><name sortKey="Gardner, David" sort="Gardner, David" uniqKey="Gardner D" first="David" last="Gardner">David Gardner</name><affiliation><nlm:aff id="af3-cjp-2015-vol60-february-52-61">Professor, Department of Psychiatry and Pharmacy, Dalhousie University, Halifax, Nova Scotia.</nlm:aff><wicri:noCountry code="subfield">Nova Scotia.</wicri:noCountry></affiliation></author><author><name sortKey="Gorman, Daniel A" sort="Gorman, Daniel A" uniqKey="Gorman D" first="Daniel A" last="Gorman">Daniel A. Gorman</name><affiliation wicri:level="4"><nlm:aff id="af4-cjp-2015-vol60-february-52-61">Assistant Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario.</nlm:aff><orgName type="university">Université de Toronto</orgName><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author></analytic><series><title level="j">Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie</title><idno type="ISSN">0706-7437</idno><idno type="eISSN">1497-0015</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Objective:</title><p>Attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD) are among the most common psychiatric diagnoses in childhood. Aggression and conduct problems are a major source of disability and a risk factor for poor long-term outcomes.</p></sec><sec><title>Methods:</title><p>We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) of antipsychotics, lithium, and anticonvulsants for aggression and conduct problems in youth with ADHD, ODD, and CD. Each medication was given an overall quality of evidence rating based on the Grading of Recommendations Assessment, Development and Evaluation approach.</p></sec><sec><title>Results:</title><p>Eleven RCTs of antipsychotics and 7 RCTs of lithium and anticonvulsants were included. There is moderate-quality evidence that risperidone has a moderate-to-large effect on conduct problems and aggression in youth with subaverage IQ and ODD, CD, or disruptive behaviour disorder not otherwise specified, with and without ADHD, and high-quality evidence that risperidone has a moderate effect on disruptive and aggressive behaviour in youth with average IQ and ODD or CD, with and without ADHD. Evidence supporting the use of haloperidol, thioridazine, quetiapine, and lithium in aggressive youth with CD is of low or very-low quality, and evidence supporting the use of divalproex in aggressive youth with ODD or CD is of low quality. There is very-low-quality evidence that carbamazepine is no different from placebo for the management of aggression in youth with CD.</p></sec><sec><title>Conclusion:</title><p>With the exception of risperidone, the evidence to support the use of antipsychotics and mood stabilizers is of low quality.</p></sec></div></front></TEI><affiliations><list><country><li>Canada</li></country><region><li>Alberta</li><li>Ontario</li></region><settlement><li>Calgary</li><li>Toronto</li></settlement><orgName><li>Université de Calgary</li><li>Université de Toronto</li></orgName></list><tree><noCountry><name sortKey="Gardner, David" sort="Gardner, David" uniqKey="Gardner D" first="David" last="Gardner">David Gardner</name></noCountry><country name="Canada"><region name="Alberta"><name sortKey="Pringsheim, Tamara" sort="Pringsheim, Tamara" uniqKey="Pringsheim T" first="Tamara" last="Pringsheim">Tamara Pringsheim</name></region><name sortKey="Gorman, Daniel A" sort="Gorman, Daniel A" uniqKey="Gorman D" first="Daniel A" last="Gorman">Daniel A. 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