Pharmacopsychiatry 2012; 45(01): 13-19
DOI: 10.1055/s-0031-1286348
Original Paper
© Georg Thieme Verlag KG Stuttgart · New York

Aripiprazole in Children and Adolescents with Conduct Disorder: A Single-Center, Open-Label Study

E. S. Ercan
1   Department of Child and Adolescent Psychiatry, Ege University School of Medicine, Bornova, Izmir, Turkey
,
T. Uysal
1   Department of Child and Adolescent Psychiatry, Ege University School of Medicine, Bornova, Izmir, Turkey
,
E. Ercan
2   Department of Psychological Counseling and Guidance, Ege University, Bornova, Izmir, Turkey
,
U. Akyol Ardic
1   Department of Child and Adolescent Psychiatry, Ege University School of Medicine, Bornova, Izmir, Turkey
› Institutsangaben
Weitere Informationen

Publikationsverlauf

received 28. Juli 2011
revised 28. Juli 2011

accepted 29. Juli 2011

Publikationsdatum:
12. Oktober 2011 (online)

Abstract

Objective:

The aim of this study was to determine the effectiveness and safety of aripiprazole in children and adolescents with both attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD).

Methods:

20 children and adolescents, ranging in age from 6–16 years, participated in a single-center, open-label study (19 to completion). We began treating patients with 2.5 mg of aripi­prazole in an open-label fashion for 8 weeks. ­Outcome measures included the Turgay DSM-IV-based child and adolescent behavior disorders screening and rating scale (T-DSM-IV), the clinical global impressions-severity and improvement scales (CGI-S and CGI-I), the child behavior checklist (CBCL), the teachers report form (TRF) and the extrapyramidal symptom rating scale (ESRS), along with laboratory assessments.

Results:

The mean daily dosage of aripiprazole at the end of 8 weeks was 8.55 mg (SD=1.73), with a maximum dosage of 10 mg. Based on the global improvement subscale of the CGI, we classified 12 of 19 patients (63.1%) as responders (very much or much improved). We observed significant improvements after aripiprazole treatment with regard to inattention, hyperactivity/impulsivity, ODD, and CD subscales of the T-DSM-IV (parent, teacher and clinician forms). We also observed significant improvements on many of the CBCL and TRF subscales (e. g., attention problems as well as delinquent and aggressive behavior). The participants tolerated aripiprazole, and no patient was excluded from the study because of adverse drug events.

Conclusion:

Aripiprazole is an effective and well-tolerated treatment for ADHD and CD symptoms; however, additional studies (specifically, placebo-controlled and double-blind studies) are needed to better define the clinical use of ­aripiprazole in children and adolescents with ADHD-CD.

 
  • References

  • 1 American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington DC: American Psychiatric Association; 1994
  • 2 Biederman J, Faraone S, Milberger S et al. A prospective 4-year follow-up study of attention-deficit hyperactivity and related disorders. Arch Gen Psychiatry 1996; 53: 437-446
  • 3 Loeber R, Green SM, Keenan K et al. Which boys will fare worse? Early predictors of the onset of conduct disorder in a six-year longitudinal study. J Am Acad Child Adolesc Psychiatry 1995; 34: 499-509
  • 4 Biederman J, Petty CR, Evans M et al. How persistent is ADHD? A controlled 10-year follow-up study of boys with ADHD. Psychiatry Res 2010; 177: 299-304
  • 5 Pliszka SR, Crismon ML, Hughes CW et al. Texas Consensus Conference Panel on Pharmacotherapy of Childhood Attention Deficit Hyperactivity Disorder. The Texas Children’s Medication Algorithm Project: Revision of the Algorithm for Pharmacotherapy of Attention-Deficit/Hyperactivity Disorder. J Am Acad Child Adolesc Psychiatry 2006; 45: 642-657
  • 6 Pliszka S. American Academy of Child and Adolescent Psychiatry Work Group on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 2007; 46: 894-921
  • 7 Burris KD, Molski TF, Xu C et al. Aripiprazole, a novel antipsychotic, is a high-affinity partial agonist at human dopamine D2 receptors. J Pharmacol Exp Ther 2002; 302: 381-389
  • 8 Jordan S, Koprivica V, Chen R et al. The antipsychotic aripiprazole is a potent, partial agonist at the human 5-HT1A receptor. Eur J Pharmacol 2002; 26; 441: 137-140
  • 9 Davies MA, Sheffler DJ, Roth BL. Aripiprazole: a novel atypical antipsychotic drug with a uniquely robust pharmacology. CNS Drug Rev 2004; 10: 317-336
  • 10 Tamminga CA. Partial dopamine agonists in the treatment of psychosis. J Neural Transm 2002; 109: 411-420
  • 11 Findling RL, Robb A, Nyilas M et al. A multiple-center, randomized, double-blind, placebo-controlled study of oral aripiprazole for treatment of adolescents with schizophrenia. Am J Psychiatry 2008; 165: 1432-1441
  • 12 Murphy TK, Mutch PJ, Reid JM et al. Open label aripiprazole in the treatment of youth with tic disorders. J Child Adolesc Psychopharmacol 2009; 19: 441-447
  • 13 Findling RL, Nyilas M, Forbes RA et al. Acute treatment of pediatric bipolar I disorder, manic or mixed episode, with aripiprazole: a randomized, double-blind, placebo-controlled study. J Clin Psychiatry 2009; 70: 1441-1451
  • 14 Findling RL, Short EJ, Leskovec T et al. Aripiprazole in children with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol 2008; 18: 347-354
  • 15 Marcus RN, Owen R, Kamen L et al. A placebo-controlled, fixed-dose study of aripiprazole in children and adolescents with irritability associated with autistic disorder. J Am Acad Child Adolesc Psychiatry 2009; 48: 1110-1119
  • 16 Tramontina S, Zeni CP, Pheula GF et al. Aripiprazole in juvenile bipolar disorder comorbid with attention-deficit/hyperactivity disorder: an open clinical trial. CNS Spectr 2007; 12: 758-762
  • 17 Findling RL, Kauffman R, Sallee FR et al. An open-label study of aripiprazole: pharmacokinetics, tolerability, and effectiveness in children and adolescents with conduct disorder. J Child Adolesc Psychopharmacol 2009; 19: 431-439
  • 18 Kaufman J, Birmaher B, Brent D et al. Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): Initial reliability and validity data. J Am Acad Child Adolesc Psychiatry 1997; 36: 980-988
  • 19 Gokler B, Unal F, Pehlivanturk B et al. Reliability and valıdıty of schedule for affective disorders and schizophrenia for school-age children-present and lifetime version  −  Turkish version (K-SADS-PL-T) [in Turkish]. Cocuk ve Genclik Ruh Saglığı Dergisi (Journal of Child and Adolescent Mental Health) 2004; 11: 3
  • 20 National Institute of Mental Health . CGI (Clinic Global Impression) Scale. Psychopharmacology Bull 1985; 21: 839-843
  • 21 Turgay A. Disruptive behavior disorders: child and adolescent screening and rating scales for children, adolescents, parents and teachers.West Bloomfield (Michigan). Integrative Therapy Institute Publication 1994;
  • 22 Ercan ES, Amado S, Somer O et al. Development of a test battery for the assessment of attention deficit hyperactivity disorder [in Turkish]. Cocuk ve Genclik Ruh Saglığı Dergisi (Journal of Child and Adolescent Mental Health) 2001; 8: 132-144
  • 23 Achenbach TM, Edelbrock C. Manual for the Child Behavior Checklist/4–18 and revised child behavior profile. Burlington, Vt: University of Vermont, Department of Psychiatry; 1983
  • 24 Erol N, Kılıç N, Ulusoy M. Mental health profile of Turkey [in Turkish], TC Sağlık Bakanlığı Temel Sağlık Hizmetleri Genel Müdürlüğü, Ankara. Turkey. 1998
  • 25 Wechsler D. Wechsler Preschool and Primary Scale of Intelligence (Revised edition). Harcourt Brace; New York: 1983
  • 26 Burke D, Loeber R, Birmaher B. Oppositional defiant disorder and conduct disorder: A review of the past 10 years, Part II. J Am Acad Child Adolesc Psychiatry 2002; 41: 1275-1293
  • 27 Olfson M, Blanco C, Liu L et al. National trends in the outpatient treatment of children and adolescents with antipsychotic drugs. Arch Gen Psychiatry 2006; 63: 679-685
  • 28 Snyder R, Turgay A, Aman M et al., Risperidone Conduct Study Group . Effects of risperidone on conduct and disruptive behavior disorders in children with subaverage IQs. J Am Acad Child Adolesc Psychiatry 2002; 41: 1026-1036
  • 29 Aman MG, De Smedt G, Derivan A et al., Risperidone Disruptive Behavior Study Group . Double-blind, placebo-controlled study of risperidone for the treatment of disruptive behaviors in children with subaverage intelligence. Am J Psychiatry 2002; 159: 1337-1346
  • 30 Findling RL, McNamara NK, Branicky LA et al. A double-blind pilot study of risperidone in the treatment of conduct disorder. J Am Acad Child Adolesc Psychiatry 2000; 39: 509-516
  • 31 Turgay A, Binder C, Snyder R et al. Long-term safety and efficacy of risperidone for the treatment of disruptive behavior disorders in children with subaverage IQs. Pediatrics 2002; 110: e34
  • 32 Findling RL, Aman MG, Eerdekens M et al. Risperidone Disruptive Behavior Study Group . Long-term, open-label study of risperidone in children with severe disruptive behaviors and below-average IQ. Am J Psychiatry 2004; 161: 677-684
  • 33 Croonenberghs J, Fegert JM, Findling RL et al., Risperidone Disruptive Behavior Study Group . Risperidone in children with disruptive behavior disorders and subaverage intelligence: a 1-year, open-label study of 504 patients. J Am Acad Child Adolesc Psychiatry 2005; 44: 64-72
  • 34 Reyes M, Buitelaar J, Toren P et al. A randomized, double-blind, placebo-controlled study of risperidone maintenance treatment in children and adolescents with disruptive behavior disorders. Am J Psychiatry 2006; 163: 402-410
  • 35 Lyon GJ, Samar S, Jummani R et al. Aripiprazole in children and adolescents with Tourette’s disorder: an open-label safety and tolerability study. J Child Adolesc Psychopharmacol 2009; 19: 623-633
  • 36 De Hert M, Dobbelaere M, Sheridan EM et al. Metabolic and endocrine adverse effects of second-generation antipsychotics in children and adolescents: A systematic review of randomized, placebo controlled trials and guidelines for clinical practice. Eur Psychiatry 2011; 26: 144-158