Treatment Recommendations for the Use of Antipsychotics for Aggressive Youth (TRAAY), Part I: A Review

Schur, Sarah B.; Sikich, Lin; Findling, Robert L.; Malone, Richard P.; Crismon, M. Lynn; Derivan, Albert T.; MacIntyre, James C.; Pappadopulos, Elizabeth; Greenhill, Laurence L.; Schooler, Nina R.; Orden, Kimberly A. Van; Jensen, Peter S.

doi:10.1176/foc.2.4.596

Cited by 33 publications

(52 citation statements)

References 98 publications

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“…15,[62][63][64] Studies with children and adolescents that used these medications, particularly for patients with schizophrenia and autism, reported favorable results. 55,57,65 However, only longitudinal prospective studies will be able to demonstrate the real impact of AAP on this population, particularly in terms of metabolic and hormone changes 1,26 associated with growth and development, although adverse events are well tolerated and manageable. [27][28][29]66 Studies that analyzed metabolic changes, such as weight gain, dyslipidemia and the risk of diabetes, have recommended that these medications should be used carefully, and that a proactive attitude should be adopted, with systematic monitoring using laboratory tests, weight control and nutritional interventions.…”

Section: Discussionmentioning

confidence: 99%

“…It is the main cause of visits to psychiatric emergence services and of hospitalizations of children and adolescents in specialized psychiatric wards. [1][2][3] It is classified as a psychopathological symptom when not an adaptive behavior, as well as when it clearly clashes with cultural standards of the social group to which the child or adolescent belongs. 4 Neurobiologically, impulsive/affective aggression may be explained as a lack of equilibrium between prefrontal mechanisms of top-down control (orbitofrontal cortex and anterior gyrus cinguli) and the bottom-up limbic stimuli (amygdala and other limbic areas), in which several neurotransmitters, such as serotonin, dopamine, noradrenalin and others, may be involved and may, therefore, be managed pharmacologically.…”

Section: Introductionmentioning

confidence: 99%

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Atypical antipsychotics in the treatment of pathological aggression in children and adolescents: literature review and clinical recommendations

Teixeira

Jacintho

Celeri

et al. 2013

Trends Psychiatry Psychother.

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Objective: To review the literature about the use of atypical antipsychotics in the treatment of pathological aggression in children and adolescents. Method: The databases MEDLINE, SciELO, and LILACS were searched for publications in Portuguese or English from 1992 to August 2011 using the following keywords: mental disease, child, adolescent, treatment, atypical antipsychotic, aggressive behavior, aggression, and violent behavior. Results: Sixty-seven studies of good methodological quality and clinical interest and relevance were identified. Studies including children and adolescents were relatively limited, because few atypical antipsychotics have been approved by the Food and Drug Administration (FDA). All the medications included in this review (risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole and clozapine) have some effectiveness in treating aggression in children and adolescents, and choices should be based on clinical indications and side effects. Conclusions: There are few studies about the effectiveness and safety of atypical antipsychotics for the pediatric population, and further randomized controlled studies with larger groups of patients and more diagnostic categories, such as severe conduct disorder and oppositional defiant disorder, should be conducted to confirm the results reported up to date and to evaluate the impact of long-term use. Keywords: Aggression, violence, atypical antipsychotics, behavioral disorders, children, adolescents. ResumoObjetivo: Realizar uma revisão sistemática da literatura científica sobre o uso de antipsicóticos atípicos (APAs) no tratamento da agressividade patológica em crianças e adolescentes. Método: Foi realizada busca eletrônica nas bases de dados MEDLINE, SciELO e LILACS, de 1992 a agosto 2011, considerando artigos publicados em língua inglesa e portuguesa. Foram utilizadas associações das seguintes expressões: mental disease, child, adolescent, treatment, atypical antipsychotic, aggressive behaviour, aggression e violent behavior. Resultados: Foram identificados 67 artigos de boa qualidade metodológica, de relevância e interesse clínico para o tema em foco. De modo geral, os estudos são relativamente limitados para esta faixa etária, resultado do fato de poucos APAs terem sido aprovados pela Food and Drug Administration (FDA). Dentre as medicações consideradas nesta revisão (risperidona, olanzapina, quetiapina, ziprazidona, aripiprazol e clozapina), todas elas podem ter alguma efetividade no tratamento da agressividade em crianças e adolescentes, ficando a escolha baseada na indicação clínica e perfil de efeitos colaterais. Conclusão: O número ainda limitado de estudos acerca da efetividade e segurança na população pediátrica demanda pesquisas futuras com grupos maiores de pacientes e com mais categorias diagnósticas (como, por exemplo, as formas graves de transtorno de conduta e transtorno desafiador de oposição), desenhadas de forma randomizada e controlada. Assim poderão ser confirmados os achados até o momento e o impacto do uso em lo...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Atypical antipsychotics in the treatment of pathological aggression in children and adolescents: literature review and clinical recommendations

Teixeira

Jacintho

Celeri

et al. 2013

Trends Psychiatry Psychother.

View full text Add to dashboard Cite

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“…Using existing guidelines (eg, ADHD guidelines from the AAP, 47,48 51,52 ); practice parameters 53,54 ; and expert opinion of task force members, the task force developed guidance to assist clinicians in further assessment of children with positive screening results or clinical findings that fall into the following clusters of symptoms:…”

Section: B5a: Provide Mental Health Assessmentmentioning

confidence: 99%

Enhancing Pediatric Mental Health Care: Algorithms for Primary Care

Foy

2010

Pediatrics

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“…linically relevant aggression and oppositionality are common treatment targets in child and adolescent psychiatry Schur et al 2003;Olfson et al 2006;Pappadopulos et al 2006;Jensen et al 2007). Disruptive behavior disorders that are frequently associated with relevant aggression and oppositionality occur in approximately 7-11% of the pediatric population (Loeber et al 2000;Nock et al 2007), with an estimated 75% referral rate to psychiatric care among children with these diagnoses (Arcelus and Vostanis 2003).…”

mentioning

confidence: 99%

“…Although they are still somewhat controversial regarding the appropriate timing and sequencing with nonpharmacologic management strategies, pharmacologic treatments, and, in particular, antipsychotics have shown to be efficacious for the symptoms of aggression and externalizing disorders Schur et al 2003;Pappadopulos et al 2006;Jensen et al 2007). There is evidence that antipsychotics can facilitate short-term reduction in symptoms of maladaptive aggression, and risperidone has been shown to be more efficacious than placebo in doubleblind, controlled studies ( Jensen et al 2007), with greater effect sizes than for other medication classes, such as mood stabilizers, stimulants, antidepressants and a2 agonists (Pappadopulos et al 2006).…”

mentioning

confidence: 99%

Lack of Effect of Stimulant Combination with Second-Generation Antipsychotics on Weight Gain, Metabolic Changes, Prolactin Levels, and Sedation in Youth with Clinically Relevant Aggression or Oppositionality

Penzner

Dudas

Saito

et al. 2009

Journal of Child and Adolescent Psychopharmacology

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Background: Second-generation antipsychotics (SGAs) are associated with weight gain, metabolic abnormalities, sedation= sleep disturbance, and prolactin abnormalities, especially in youths. Although stimulants have opposing dopamine receptor and adverse effects, it is unclear whether stimulant co-treatment counteracts the therapeutic or side effects of antipsychotics. Methods: This was a naturalistic cohort study including 153 antipsychotic trials in youths aged 4-19 (mean, 11.3 AE 3.0) years, started on an SGA for clinically significant aggression or oppositionality associated with oppositional defiant disorder, conduct disorder, disruptive behavior disorder not otherwise specified (NOS), impulse control disorder NOS, intermittent explosive disorder, Tourette's disorder, autistic disorder, and pervasive developmental disorder NOS. Patients underwent fasting assessments of body composition, lipids, glucose, insulin, prolactin, sedation, and general efficacy at baseline, weeks 4, 8, and 12, comparing patients co-prescribed stimulants (n ¼ 71) with those not co-prescribed stimulants (n ¼ 82). Results: Patients received risperidone (33.3%), aripiprazole (29.4%), quetiapine (18.4%), olanzapine (11.8%), ziprasidone (5.9%), or clozapine (0.7%). With and without adjustment for differences in baseline variables (sex, prior stimulant use, primary Diagnostic and Statistical Manual of Mental Disorders, 4 th edition [DSM-IV] disorders, co-morbid attentiondeficit=hyperactivity disorder [ADHD], present in 46.3% of youths not receiving stimulants, and some body composition parameters), patients on versus off stimulants did not differ on any of the assessed outcomes (all p values ! 0.1). Conclusions: In contrast to guidelines, stimulant use did not precede or accompany antipsychotic use during the current episode of aggression=oppositionality in almost half of those youths who had aggressive=oppositional behavior and a DSM-IV diagnosis of ADHD. At the clinically prescribed doses, stimulant co-treatment of SGAs did not seem to significantly reduce antipsychotic effects on body composition, metabolic parameters, prolactin, sedation, and broad efficacy.

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Treatment Recommendations for the Use of Antipsychotics for Aggressive Youth (TRAAY), Part I: A Review

Cited by 33 publications

References 98 publications

Atypical antipsychotics in the treatment of pathological aggression in children and adolescents: literature review and clinical recommendations

Atypical antipsychotics in the treatment of pathological aggression in children and adolescents: literature review and clinical recommendations

Enhancing Pediatric Mental Health Care: Algorithms for Primary Care

Lack of Effect of Stimulant Combination with Second-Generation Antipsychotics on Weight Gain, Metabolic Changes, Prolactin Levels, and Sedation in Youth with Clinically Relevant Aggression or Oppositionality

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