Carbamazepine conduct disorders

A child with attention-deficit hyperactivity disorder [ADHD] and conduct disorder is treated with 45 mg/d of methylphenidate and 2 mg/d of risperidone. A new diagnosis of complex partial seizures is made and the child is started on carbamazepine. About 10 days after the initiation of carbamazepine, the child develops withdrawal dyskinesias of mouth and tongue. After discontinuation of carbamazepine, the movements last for 1 week. 

Cueva, J.E., Overall, J.E., Small, A.M., Armenteros, J.L., Perry, R., and Campbell, M. (1996) Carbamazepine in aggressive children with conduct disorder a double-blind and placebo-controlled study. J Am Acad Child Adolesc Psychiatry 35 480-490. 

Kafantatis, V, Campbell, M., Padron-Gayol, M.V., Small, A.M., Lo-cascio, JJ-, and Rosenbetg, C.R. (1992) Carbamazepine in hospitalized aggtessive conduct disorder children an open pilot study. Psychopharmacol Bull 28 193-199. [published erratum ap-peats in Psychopharmacol Bull 1992 28(3) 220]. 

Lithium, carbamazepine, valproate, and antipsychotics have all been tried, with variable success, as therapy for conduct disorder in typically developing... 

Divalproex (Depakote) was found to reduce temper outbursts and emotional lability in 10 adolescents with conduct disorder (Donovan et al., 1997). Studies of carbamazepine have yielded conflicting results. Cueva et al. (1996) did not find carbamazepine to be more effective than placebo in treating children hospitalized for conduct disorder in a double-blind, placebo-controlled study. As in the case of lithium, side effects (rashes, leukopenia, nausea, drowsiness) can be an issue with carbamazepine, offsetting its use. 

Aman s (1993) review of lithium treatment for self-injury revealed that the drug has only inconsistently been shown to suppress such behaviors. The available case reports have been far more positive than the placebo controlled research. Kastner et al. s (1993) positive but uncontrolled study of lithium in adolescents and adults practicing aggression and self-injury was described earlier (see Conduct Disorder, above). Finally, single-subject studies of carbamazepine have yielded mixed results (Aman, 1993). 

Anticonvulsants have sedative side effects and therefore drugs such as carbamazepine have occasionally been used to treat conduct disorders. There is no evidence that such drugs are useful in the control of aggressive symptoms. 

Based on theories that mania may kindle further episodes of mania, a logical parallel with seizure disorders was drawn, since seizures can kindle more seizures. Thus, trials of several anticonvulsants, beginning with carbamazepine, have been conducted, and several are showing indications of efficacy in treating the manic phase of bipolar disorder (Table 7—1). Only valproic acid, however, is actually approved for this indication. 

Adverse effects include CNS symptoms (reversible blurring of vision, diplopia, dizziness and ataxia) and depression of cardiac AV conduction. Alimentary symptoms, skin rashes, blood disorders and liver and kidney dysfunction also occur. Osteomalacia by enhanced metabolism of vitamin D (enzyme induction) occurs over years so also does folate deficiency. Enzyme induction reduces the efficacy of combined and progestogen-only contraceptives. Carbamazepine impairs cognitive function less than phenytoin. 

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