Mood disorders aggression

The molten carbonate fuel ceU uses eutectic blends of Hthium and potassium carbonates as the electrolyte. A special grade of Hthium carbonate is used in treatment of affective mental (mood) disorders, including clinical depression and bipolar disorders. Lithium has also been evaluated in treatment of schizophrenia, schizoaffective disorders, alcoholism, and periodic aggressive behavior (56). 

In 1992, an open study of 22 psychiatric inpatients, ages 5 to 12 years, with disruptive behavioral and mood disorders were treated with trazodone. The results revealed a significant decrease in aggressive and impulsive behaviors in 13 of the patients following therapy with trazodone (Zubieta and Alessi, 1992). 

Aggression is an important component of mood disorders. Thus, a measure that captures the frequency and severity of the child s outbursts, such as the Overt Aggression Scale (OAS Yudofsky et ah, 1986), may be useful. This rating was evaluated in one inpatient study, and appears to be reliable and valid (Kafantaris et ah, 1996). Behavior disorder rating scales that measure ADHD and ODD are also likely to be useful. As noted above, our clinic uses a combined Child and Adolescent Symptom Inventory both at baseline and to follow treatment response, as it provides a comprehensive rating of symptoms (Grayson and Carlson, 1991 Gadow et al., 1999). 

Mood dysregulation and/or thought disturbance increase the probability of aggression. Recent data suggest a link between mental illness and violence individuals with psychotic or mood disorders are five times more likely to engage in violence than those in the normal population. Substance abuse more than doubles this risk (Swartz et ah, 1998). 

Youth with affective illness are at greater risk for aggression. For example, among juvenile sex offenders, 35%-50% had comorbid mood disorders (Plizka et al., 2000). 

Lithium has been proven effective for acute and prophylactic treatment of both manic and depressive episodes in patients with bipolar illness (American Psychiatric Association 2002). However, patients with rapid-cycling bipolar disorder (i.e., patients who experience four or more mood disorder episodes per year) have been reported to respond less well to lithium treatment (Dunner and Fieve 1974 Prien et al. 1984 Wehr et al. 1988). Lithium is also effective in preventing future depressive episodes in patients with recurrent unipolar depressive disorder (American Psychiatric Association 2002) and as an adjunct to antidepressant therapy in depressed patients whose illness is partially refractory to treatment with antidepressants alone (discussed in Chapter 2). Furthermore, hthium may be useful in maintaining remission of depressive disorders after electroconvulsive therapy (Coppen et al. 1981 Sackeim et al. 2001). Lithium also has been used effectively in some cases of aggression and behavioral dyscontrol. 

For such patients, aggressive treatment of their mood disorder may be particularly important in achieving and maintaining sobriety. 

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. 

The breakdown of PAEs caused by SSRIs in this study was ominous. Of the 82 children, 21% developed mood disorders, including 15% who became irritable, 10% who became anxious, 9% who became depressed, and 6% who became manic. In addition, 4% of the children became aggressive. Sleep disorders afflicted 35% of the children, including 23% feeling drowsy and 17% experiencing insomnia. Finally, 10% became psychotic ... 

Eight of a heterogeneous group of eleven children and adolescents (mean age 9.8, range 5.5-16 years) with mood disorders and aggressive behavior, improved with a low dose of risperidone (0.75-2.5 mg/day) (7). Treatment was stopped in two children because of drowsiness the most bothersome adverse effect of risperidone was weight gain in two cases (mean increase 4 kg). 

Schreier HA. Risperidone for young children with mood disorders and aggressive behavior. J Child Adolesc Psychopharmacol 1998 8(l) 49-59. 

Clobazam is better tolerated than other benzodiazepines used in epilepsy (5). Its most common adverse effects are mild and transient drowsiness, dizziness, or fatigue rather less common are muscle weakness, restlessness, aggressiveness, weight increase, ataxia, mood disorders, psychotic and behavioral disturbances, vertigo, hypotonia, hypersalivation, and edema (SED-13, 152). There may be a loss of therapeutic response over time. 

Two elderly patients with Alzheimer s disease and a mood disorder were treated with donepezil 5 mg/day and paroxetine 20 mg/day. One of them became agitated, confused, and aggressive, and donepezil was withdrawn after 8 days. On reintroduction of donepezil she again became rapidly confused, irritable, and verbally aggressive. In the other case, while the patient was taking paroxetine, donepezil 5 mg/day resulted in severe diarrhea, flatulence, and insomnia. The dosage of donepezil was reduced to 5 mg on alternate days, but the diarrhea and flatulence persisted. The symptoms resolved when donepezil was stopped. 

In addition to its use in mood disorders, lithium has been suggested or examined in a wide range of neuropsychiatric conditions. Lithium is one of the pharmaceuticals that is frequently recommended for the management of aggressive behavior independent of diagnosis. In a review of 16 published studies, 7 or 8 (depending on definition of response) were foxmd to be positive [43" " ], and indeed, it appears to reduce impulsive behavior in rats—a characteristic not shared by tire otiier common mood stabilizers, carbamazepine, or valproate [44an nia> study]... 

Depression and mania are both affective disorders but their symptoms and treatments are quite distinct. Mania is expressed as heightened mood, exaggerated sense of self-worth, irritability, aggression, delusions and hallucinations. In stark contrast, the most obvious disturbance in depression is melancholia that often co-exists with behavioural and somatic changes (Table 20.1). Some individuals experience dramatic mood swings between depression and mania. This is known as "bipolar disorder which, like mania itself, is treated with lithium salts or neuroleptics. 

When these measures have failed and impulsivity and aggression remain a problem, additional strategies are available. First, reconsider the diagnosis. Does the patient have bipolar disorder rather than ADHD Is there another disruptive behavior disorder in addition to or instead of ADHD Does (s)he have an impulse control disorder In these more severe cases, other medications such as atypical antipsychot-ics or mood stabilizers are often helpful. 

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