Divalproex treatment for youth with explosive temper and mood lability: A double-blind, placebo-controlled crossover design
ABSTRACT The authors sought to replicate open-label findings showing that specific criteria for explosive temper and mood lability identify disruptive youth who improve while receiving the anticonvulsant divalproex sodium.
Twenty outpatient children and adolescents (ages 10-18) with a disruptive behavior disorder (oppositional defiant disorder or conduct disorder) met the specific criteria for explosive temper and mood lability. They received 6 weeks of divalproex treatment and 6 weeks of placebo by random assignment. Independent evaluators blind to group assignment assessed response at the end of each phase.
At the end of phase 1, eight of 10 subjects had responded to divalproex; zero of 10 had responded to placebo. Of the 15 subjects who completed both phases, 12 has superior response taking divalproex.
This preliminary study replicates open-label findings showing that divalproex is an efficacious treatment for explosive temper and mood lability in disruptive children and adolescents.
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- "Plusieurs e ´ quipes ont montré leur inté rêt, notamment la fluoxé tine  et le citalopram . Selon les ré sultats de deux e ´ tudes randomisé es, le divalproate de sodium serait efficace dans la prise en charge de l'impulsivité et l'hostilité aussi bien chez les adolescents que chez les adultes  . Hollander et al.  ont publié e ´ galement les ré sultats d'une e ´ tude multicentrique randomisé e dans laquelle ils ont e ´ tudié la dimension d'agressivité dans trois pathologies : les troubles de la personnalité du cluster B, les troubles explosifs intermittents et le syndrome de stress post-traumatique. "
ABSTRACT: Drug treatment of personality disorders is less developed than are psychological treatments in this area, but they are a logical prolongation of psychobiological models of personality and temperament, and respond to the need of many clinicians in front of difficult patients. The results obtained in the field of pharmacotherapy of personality disorders can be classified according to DSM-IV axis-II categorization. In anxious personalities (clusterC), some isolated studies suggest a favourable effect of antidepressants on obsessive-compulsive dimension, on avoidant personality disorder, and on inhibition and trait-anxiety, especially when serotoninergic agents are used. Few studies have been conducted in cluster A personality disorders, and some are in favour of the interest of low doses of antipsychotic drugs in this group. Most studies have been conducted in cluster B, and especially in antisocial and borderline personality disorders. Partial positive results have been obtained using various classes of drugs for dealing with aggression and impulsive behaviors, including lithium, beta-blockers, carbamazepine, valproate, antipsychotic drugs, and also SSRIs. Self-harm and suicidal behaviors seem to be partially but significantly improved by antidepressants and low doses of antipsychotics. Overall, the pharmacotherapy of personality disorder may lead in the future to the development of effective treatments, in complement to psychotherapy, for actually severe, chronic, and disabling disorder.Annales Médico-psychologiques revue psychiatrique 11/2011; 169(9):592-594. DOI:10.1016/j.amp.2011.09.001 · 0.15 Impact Factor
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- "The few well-controlled medication studies targeting child or adolescent aggression have found the atypical antipsychotic drug risperidone effective for reducing aggressive behaviors in youth with CD (Findling et al., 2000), with below-average IQ (Aman et al., 2002; Buitelaar, van der Gaag, Cohen-Kettenis, & Melman, 2001), and with autism (McCracken et al., 2002). Stimulant medications and alpha agonists used in treating ADHD have been found effective in reducing aggression associated with ADHD and possibly also CD (Klein et al., 1997; see also Hinshaw, 1991), and the mood stabilizing drugs lithium and divalproex sodium have been found effective in reducing aggression in children and adolescents with CD (Donovan et al., 2000; Malone, Delaney, Luebbert, Carter, & Campbell, 2000). In general, medications tend to produce highly variable treatment response among youth with disruptive behavior disorders. "
ABSTRACT: This article reviews the literature from 1996 to 2007 to update the 1998 Brestan and Eyberg report on evidence-based psychosocial treatments (EBTs) for child and adolescent disruptive behavior, including oppositional defiant disorder and conduct disorder. Studies were evaluated using criteria for EBTs developed by the task force on promotion and dissemination of psychological procedures (Chambless et al., 1998; Chambless et al., 1996). Sixteen EBTs were identified in this review, up from 12 in the earlier report, and 9 "possibly efficacious" treatments (Chambless & Hollon, 1998) were identified as well. This article describes the EBTs and their evidence base and covers research on moderators and mediators of treatment outcome, as well as the clinical representativeness and generalizability of the studies. Best practice recommendations from the current evidence base also are offered, as well as calls for future research that increases understanding of the moderators and mechanisms of change for children and adolescents with disruptive behavior disorders.Journal of Clinical Child & Adolescent Psychology 02/2008; 37(1):215-37. DOI:10.1080/15374410701820117 · 1.92 Impact Factor
- "Lithium has been shown to reduce aggression in youth with CD (Campbell et al. 1995, Malone et al. 1994, Malone et al. 2000), though one study failed to find lithium to be effective in this population (Rifkin et al. 1997). Studies indicate that aggression in youth with disruptive behavior disorders is reduced by treatment with atypical antipsychotics including haloperidol (Campbell et al. 1984) and risperidone (Findling et al. 2000), as well as mood stabilizers, such as divalproex (Donovan et al. 2000, Steiner et al. 2003), although another study found valproate to be ineffective in reducing irritability in a sample of aggressive children with PDD (Hellings et al. 2005). However, in children with autism, risperidone significantly reduced aggressive behavior (McCracken et al. 2002) and irritability (Shea et al. 2004). "
Article: Irritability in pediatric mania[Show abstract] [Hide abstract]
ABSTRACT: Although the study of pediatric bipolar disorder (BPD) and childhood mania is of increasing interest, clinical criteria for diagnosing the illness in children continue to be debated. The role of irritability is central to this controversy. Of particular importance is whether irritable mood (as opposed to euphoria/grandiosity) is sufficient to diagnose pediatric mania, and if mania is characterized by episodic (as opposed to chronic) irritability. This article discusses these issues in an effort to clarify the associations among irritability, mania, and pediatric BPD. In addition, although the term irritability is used frequently, there are few clearly operationalized definitions of irritability and few validated and reliable measures to assess it. We also discuss the pathophysiology of irritability and provide a developmental perspective. Finally, we discuss pharmacological and psychotherapeutic strategies for treating irritability in pediatric mania.