Divalproex treatment for youth with explosive temper and mood lability: A double-blind, placebo-controlled crossover design

Columbia University, New York, New York, United States
American Journal of Psychiatry (Impact Factor: 13.56). 06/2000; 157(5):818-20. DOI: 10.1176/appi.ajp.157.5.818
Source: PubMed

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 [4] et le citalopram [15]. 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 [5] [7]. Hollander et al. [8] 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. "
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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. "
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    • "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). "
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