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Meta-Analysis
. 2015 Feb;60(2):52-61.
doi: 10.1177/070674371506000203.

The pharmacological management of oppositional behaviour, conduct problems, and aggression in children and adolescents with attention-deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder: a systematic review and meta-analysis. Part 2: antipsychotics and traditional mood stabilizers

Tamara Pringsheim  1 , Lauren Hirsch  2 , David Gardner  3 , Daniel A Gorman  4
Affiliations
Meta-Analysis

The pharmacological management of oppositional behaviour, conduct problems, and aggression in children and adolescents with attention-deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder: a systematic review and meta-analysis. Part 2: antipsychotics and traditional mood stabilizers

Tamara Pringsheim et al. Can J Psychiatry. 2015 Feb.

Abstract
in English, French

Objective: Attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD) are among the most common psychiatric diagnoses in childhood. Aggression and conduct problems are a major source of disability and a risk factor for poor long-term outcomes.

Methods: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) of antipsychotics, lithium, and anticonvulsants for aggression and conduct problems in youth with ADHD, ODD, and CD. Each medication was given an overall quality of evidence rating based on the Grading of Recommendations Assessment, Development and Evaluation approach.

Results: Eleven RCTs of antipsychotics and 7 RCTs of lithium and anticonvulsants were included. There is moderate-quality evidence that risperidone has a moderate-to-large effect on conduct problems and aggression in youth with subaverage IQ and ODD, CD, or disruptive behaviour disorder not otherwise specified, with and without ADHD, and high-quality evidence that risperidone has a moderate effect on disruptive and aggressive behaviour in youth with average IQ and ODD or CD, with and without ADHD. Evidence supporting the use of haloperidol, thioridazine, quetiapine, and lithium in aggressive youth with CD is of low or very-low quality, and evidence supporting the use of divalproex in aggressive youth with ODD or CD is of low quality. There is very-low-quality evidence that carbamazepine is no different from placebo for the management of aggression in youth with CD.

Conclusion: With the exception of risperidone, the evidence to support the use of antipsychotics and mood stabilizers is of low quality.

Objectif :: Le trouble de déficit de l’attention avec hyperactivité (TDAH), le trouble oppositionnel avec provocation (TOP) et le trouble des conduites (TC) sont parmi les diagnostics psychiatriques les plus communs dans l’enfance. L’agressivité et les problèmes de conduite sont une source majeure d’incapacité et un facteur de risque de mauvais résultats à long terme.

Méthodes :: Nous avons effectué une revue systématique et une méta-analyse des essais randomisés contrôlés (ERC) d’antipsychotiques, de lithium, et d’anticonvulsivants pour l’agressivité et les problèmes de conduite chez des adolescents souffrant du TDAH, du TOP et du TC. Chaque médicament a reçu une qualité globale de classement des données probantes, selon l’approche de classement de l’analyse, de l’élaboration et de l’évaluation des recommandations.

Résultats :: Onze ERC d’antipsychotiques et 7 ERC de lithium et d’anticonvulsivants ont été inclus. Des données probantes de qualité modérée indiquent que la rispéridone a un effet de modéré à grand sur les problèmes de conduite et l’agressivité chez les adolescents ayant un QI sous la moyenne et un TOP, un TC ou un trouble de comportement perturbateur non spécifié, avec et sans TDAH. Des données probantes de qualité élevée indiquent que la rispéridone a un effet modéré sur le comportement perturbateur et agressif chez les adolescents ayant un QI moyen et un TOP ou un TC, avec et sans TDAH. Les données probantes soutenant l’utilisation d’halopéridol, de thioridazine, de quétiapine, et de lithium chez les adolescents agressifs souffrant de TC sont de qualité faible ou très faible, et les données probantes soutenant l’utilisation de divalproex chez les adolescents agressifs souffrant du TOP ou du TC sont de faible qualité. Des données probantes de qualité très faible indiquent que la carbamazépine n’est pas différente d’un placebo pour la prise en charge de l’agressivité chez les adolescents souffrant du TC.

Conclusion :: À l’exception de la rispéridone, les données probantes soutenant l’utilisation des antipsychotiques et des régulateurs de l’humeur sont de faible qualité.

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Figures

Figure 1
Figure 1
Risperidone, compared with placebo, for conduct problems and aggression in youth with subaverage or low IQ and oppositional defiant disorder, conduct disorder, or disruptive behaviour disorder not otherwise specified, with and without attention-deficit hyperactivity disorder
Figure 2
Figure 2
Risperidone, compared with placebo, for disruptive behaviour and aggression in youth with oppositional defiant disorder or conduct disorder, with and without attention-deficit hyperactivity disorder
Figure 3
Figure 3
Lithium, compared with placebo, for aggression in youth with conduct disorder
Figure 4
Figure 4
Divalproex, compared with placebo, for aggressive behaviour in youth with oppositional defiant disorder or conduct disorder, with and without attention-deficit hyperactivity disorder
See this image and copyright information in PMC

References

    1. Brault MC, Lacourse E. Prevalence of prescribed attention-deficit hyperactivity disorder medications and diagnosis among Canadian preschoolers and school-age children: 1994–2007. Can J Psychiatry. 2012;57(2):93–101. - PubMed
    1. Breton JJ, Bergeron L, Valla JP, et al. Quebec Child Mental Health Survey: prevalence of DSM-III-R mental health disorders. J Child Psychol Psychiatry. 1999;40(3):375–384. - PubMed
    1. Maughan B, Rowe R, Messer J, et al. Conduct disorder and oppositional defiant disorder in a national sample: developmental epidemiology. J Child Psychol Psychiatry. 2004;45(3):609–621. - PubMed
    1. Pingault JB, Côté SM, Lacourse E, et al. Childhood hyperactivity, physical aggression and criminality: a 19-year prospective population-based study. PLoS ONE. 2013;8(5):e62594. - PMC - PubMed
    1. Klassen AF, Miller A, Fine S. Health-related quality of life in children and adolescents who have a diagnosis of attention-deficit/hyperactivity disorder. Pediatrics. 2004;114:e541. - PubMed

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