Conduct disorder aggression

Serotonin-Boosting Antidepressants. Antidepressants that enhance serotonin activity in the brain have also been studied in ADHD. In particular, fluoxetine (Prozac) and the serotonin-selective TCA clomipramine (Anafranil) have been the most extensively evaluated, with mixed success. They provide some benefit for aggression and impulsivity but don t significantly improve the poor attention of ADHD. As a result, the SSRls and other serotonin-boosting antidepressants do not appear to be effective first-line treatments for ADHD. Conversely, depressed patients without ADHD often show improvements in symptoms of concentration and attention when treated with a SSRI. Although SSRls are not widely used in the treatment of ADHD, they may be worthy of consideration in ADHD patients whose impulsivity is not controlled by stimulants alone. Those with comorbid conduct disorder or ODD who are prone to agitation and at times violent outbursts may be helped by the addition of a SSRI. 

Hyperactivity- For the short-term treatment of hyperactive children who show excessive motor activity with accompanying conduct disorders consisting of some or all of the following symptoms Impulsivity, difficulty sustaining attention, aggressivity, mood lability, and poor frustration tolerance. 

There have been recent advances in the understanding in brain structure and function of some childhood psychiatric disorders however, no controlled neuroimaging studies involving aggressive childhood disorders and conduct disorders have been published (Peterson, 1995). Despite the fact that ADHD and conduct disorders are commonly comorbid, existent imaging studies of ADHD are not informative, because typically these studies have excluded youths with conduct disorder. 

Cadoret, R.J., Yates, W.R., Troughton, E., Woodworth, G., and Stewart, M.A.(1995) Genetic-environmental interaction in the genesis of aggressivity and conduct disorders. Arch Gen Psychiatry 52 916-924. 

Connor, D.F., Barkley, R.A., and Davis, H.T (2000) A pilot study of methylphenidate, clonidine, or the combination in ADHD comorbid with aggressive oppositional defiant or conduct disorder. Clin Pediatr 39 15-25. 

Some (Campbell et ah, 1995 Malone, et ah, 2000) but not all (Rifkin et ah, 1997), controlled studies of lithium among children with conduct disorder (CD) appear to support lithium s efficacy in the treatment of aggression in this population. Both aggression and irritability are symptoms that cut across diverse disorders and are important confounders in studies of impulse dyscontrol. Double-blind controlled studies are needed to further validate the choice of lithium for patients with BD presenting with excessive irritability and anger outbursts (Fava, 1997). 

Campbell, M., Adams, P.B., Small, A.M., Kafantaris, V., Silva, R.R., Shell, J., Perry, R., and Overall, J.E. (1995) Lithium in hospitalized aggressive children with conduct disorder a double-blind and placebo-controlled study. / Am Acad Child Adolesc Psychiatry 34 445-453. [published erratum appears in / Am Acad Child Adolesc Psychiatry 1995 34(5) 694]. ... 

Kaplan, S.L., Busner, J., Kupietz, S., Wasserman, E., and Segal, B. (1990) Effects of methylphenidate on adolescents with aggressive conduct disorder and ADDH a preliminary report. J Am Acad Child Adolesc Psychiatry 29 719-723. 

Because the symptoms are so disruptive to the family and to the child, conduct disorder is one of the most common reasons for referral to a pediatrician or child psychiatrist. In patients with MR, this disorder is seen less as organized, planned illicit activities and more as impulsive, unpredictable acts of violence or destruction. Such individuals may exhibit aggression toward caregivers, teachers, family members, or themselves, and they may be emotionally labile. If behavior therapy has not been effective, pharmacological treatment may be necessary. 

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). 

Bipolar Disorder and Aggression Comorbidity with Conduct Disorder... 

Kafantaris, V., Campbell, M., Padron-Gayol, M.V., Small, A.M., Lo-cascio, JJ-, and Rosenberg, C.R. (1992) Carbamazepine in hospitalized aggressive conduct disorder children an open pilot study. Psychopharmacol Bull 28 193—199. 

Malone, R.P., Delaney, M.A., Luebbert, J.F., Cater,/., and Campbell, M. (2000) A double-blind placebo-controlled study of lithium in hospitalized aggressive children and adolescent with conduct disorder. Arch Gen Psychiatry 57 649-654. 

Bipolar disorder, manic prophylaxis of bipolar disorder MDD aggressive behavior, conduct disorder adjunct treatment in refractory MDD... 

Bipolar disorder, aggressive behavior, conduct disorder, seizure disorders... 

In another study, 118 children with IQs ranging from 35 to 84 who demonstrated conduct disorder were randomized to risperidone (at a mean dose of 1.23 mg/day) versus placebo in a double-blind design (96). In comparison with placebo, risperidone produced a statistically significant reduction in insecure/anxious behavior, hyperactivity, self-injurious/stereotyped behavior, irritability, and aggressive/destructive behavior, as well as an increase in adaptive social behavior. The latter is important because it shows that the changes are not due to sedation, although more somnolence was apparent with risperidone. 

Both typical (e.g., haloperidol) and atypical (e.g., clozapine) antipsychotics are used in children and adolescents, primarily to treat schizophrenia, psychotic mood disorder, and pervasive developmental disorders. These agents are also used on occasion to treat a range of other conditions including conduct disorder, impulsive and aggressive disorders, Tourette s disorder, and ADHD. 

Campbell M, Adams PB, Small AM. Lithium in hospitalized aggressive children with conduct disorder a double blind placebo controlled study. J Am Acad Child Adolesc Psychiatry 1995 34 445-453. 

FIGURE 10-5. Aggressive symptoms and hostility are associated with several conditions in addition to schizophrenia, including bipolar disorder, attention deficit hyperactivity disorder (ADHD) and conduct disorder (conduct dis.), childhood psychosis, Alzheimer s and other dementias, and borderline personality disorder, among others. 

Although aggressive symptoms are common in schizophrenia, they are far from unique to this condition. Thus, these same symptoms are frequently associated with bipolar disorder, childhood psychosis, borderline personality disorder, drug abuse, Alzheimer and other dementias, attention deficit hyperactivity disorder, conduct disorders in children, and many others (Fig. 10—5). 

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