Effectiveness of lithium in children and adolescents with conduct disorder: a retrospective naturalistic study.

摘要: Background: The most severe forms of conduct disorder (CD) are disabling conditions, often resistant to treatment and likely evolve into antisocial behaviours. Mood stabilizers atypical antipsychotics used treat cases CD, as antidepressants psychostimulants less frequently, despite a relative lack efficacy data. Use lithium in hospitalized children adolescents with CD has been evaluated small number studies. Aim: To explore the tolerability (administered either monotherapy or association antipsychotics) identify variables associated positive negative responses such treatment. Methods: This retrospective study included 60 consecutive patients (46 males 14 females; range 8–17 years; mean age 14.2 ± 2.4 years) who were treated for diagnosed on basis Kiddie-Schedule Affective Disorders Schizophrenia-Present Lifetime (K-SADS-PL) clinical interview DSM-IV criteria CD. sample consisted 44 inpatients (who remained hospital during first 2 3 weeks then assessed outpatients) 16 outpatients; follow-up period was 6–12 months (mean 8.4 2.2 months). While all initially lithium, an antipsychotic could be added if necessary achieve satisfactory control symptoms. Outcome measures Modified Overt Aggression Scale (MOAS), Clinical Global Impression-Severity (CGI-S) Impression-Improvement (CGI-I) scales, Questionnaire (which type aggression, i.e. predatory vs affective). Patients considered responders pharmacological at end they satisfied following criteria: ≥50% decrease MOAS score, CGI-I score 1 (‘very much improved’ ‘much improved’) CGI-S ≤3. Effect sizes calculated differences between pre- post-treatment total individual aggression dimension scores (an effect size >0.8 indicates good efficacy). Results: At follow-up, 29 (48.3%) classified (10 receiving 19 plus therapy). For whole, improved significantly (p < 0.001) (pre- posttreatment) 1.03. Mean verbal, physical towards objects other persons scores, both taking those also add-on antipsychotic, ≥0.80 items. Improvement self-aggression 0.59 found when therapy. Predictors response disease baseline, lower impulsive (affective, nonpredatory) aggression. Gastrointestinal adverse effects, polydipsia increased urinary frequency, tremor thyroid stimulating hormone levels frequently reported effects. Two discontinued because effects (vomiting dysfunction). Conclusion: Lithium alone combination may reduce aggressive behaviours therapy relatively common but rarely severe.