Hostname: page-component-5b777bbd6c-kmmxp Total loading time: 0 Render date: 2025-06-25T18:59:17.417Z Has data issue: false hasContentIssue false
  • English
  • Français

Psychopharmacologic Strategies for the Treatment of Aggression in Juveniles

Published online by Cambridge University Press:  07 November 2014

Hans Steiner ,
Kirti Saxena  and
Kiki Chang
Get access Rights & Permissions [Opens in a new window]

Abstract

Maladaptive aggression in youth is one of the most common and troublesome reasons for referrals to child psychiatrists. It has a complex relationship with psychopathology. There are several syndromes, which are primary disturbances of clustered maladaptive aggression, most notably oppositional defiant disorder and conduct disorder. However, problems with aggression also appear in a wide range of other disturbances, such as bipolar disorder, posttraumatic stress disorder, and mood disorders. Additionally, aggression is normative, serves an adaptive purpose and can be situationally induced. These complexities need to be carefully addressed before targeting maladaptive aggression psychopharmacologically. We summarize the literature on the psychopharmacology of maladaptive aggression in youth, focusing on disorders without cognitive impairment. We delineate the subtypes of aggression which are most likely to respond to medication (reactive-affective-defensive-impulsive in their acute and chronic form) and conclude with a discussion of specific medication strategies which are supported by controlled clinical trials and clinical experience.

Type
Review
Information
CNS Spectrums , Volume 8 , Issue 4: Pediatric Psychopharmacology , April 2003 , pp. 298 - 308
Copyright
Copyright © Cambridge University Press 2003

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

REFERENCES

1.Steiner, H, Karnik, N. Child or Adolescent Antisocial Behavior. In: Sadock, BJ, Sadock, VA, eds. Comprehensive Textbook Of Psychiatry. VIII. Vol 2. New York, NY: Williams & Wilkins; 2003.Google Scholar
2.Connor, DF. Aggression and Antisocial Behavior in Children and Adolescents. New York, NY: Guilford Press; 2002.Google Scholar
3.Steiner, H. The evaluation and management of aggression in juveniles. New Directions in Psychiatry. 2002;22:355–369.Google Scholar
4.Steiner, H, Redlich, A. Child psychiatry and juvenile justice. In: Lewis, M, ed. Child Psychiatry. New York, NY: Williams & Wilkins; 2002:1417–1425.Google Scholar
5.Schur, SB, Sikich, L, Findling, R, et al.Treatment recommendations for the use of antipsychotics for aggressive youth (TRAAY). Part 1: a review. J Am Acad Child Adolesc Psychiatry. 2003;42:132–44.CrossRefGoogle Scholar
6.Pappadopulos, E, MacIntyre, JC, Crismon, L, et al.Treatment recommendations for the use of antipsychotics for aggressive youth (TRAAY). Part II. J Am Acad Child Adolesc Psychiatry. 2003;42:145–61.CrossRefGoogle ScholarPubMed
7.Webster's Dictionary. 10th ed. Springfield, Mass: Merriam–Webster; 1993: 23.Google Scholar
8.Swann, AC, Bjorn, JM, Moeller, FG, Dougherty, DM. Two models of impulsivity: relationship to personality traits and psychopathology. Biol Psychiatry. 2002;51:988–994.CrossRefGoogle ScholarPubMed
9.Steiner, H, Wilson, J. In: Hendren, R, ed. Review of Psychiatry: Disruptive Behavior Disorders in Children and Adolescents. Washington, DC: American Psychiatric Association; 1999;18:47–98.Google Scholar
10.Steiner, H. Practice parameters for the assessment and treatment of children and adolescents with conduct disorder. J Am Acad Child Adolesc Psychiatry. 1997;36(suppl 10):122S–139S.CrossRefGoogle ScholarPubMed
11.Barratt, ES, Stanford, MS, Kent, TA, Felthous, A. Neuropsychological and cognitive psychophysiological substrates of impulsive aggression. Biol Psychiatry. 1997;41:1045–1061.CrossRefGoogle ScholarPubMed
12.Vitiello, B, Stoff, DM. Subtypes of aggression and their relevance to child psychiatry. J Am Acad Child Adolesc Psychiatry. 1997;36:307–315.CrossRefGoogle ScholarPubMed
13.Loeber, R, Farrington, DP. Young children who commit crime: epidemiology, developmental origins, risk factors, early interventions, and policy implications. Developmental Psychopathology. 2000;12:737–762.CrossRefGoogle ScholarPubMed
14.American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Assoication; 1994.Google Scholar
15.Connor, DF, Glatt, SJ, Lopez, ID, Jackson, D, Melloni, RH. Psychopharmacology and aggression. I: Meta-analysis of stimulant effects on overt/covert aggression-related behaviors in ADHD. J Am Acad Child Adolesc Psychiatry. 2002;41:253–261.CrossRefGoogle ScholarPubMed
16.Vitaro, F, Brendgen, M, Tramblay, R. Reactively and proactively aggressive children: antecedent and subsequent characteristics. J Child Psychol Psychiatr. 2002;43:495–505.CrossRefGoogle ScholarPubMed
17.Malone, RP, Sheikh, R, Zito, JM. Novel antipsychotic medications in the treatment of children and adolescents. Psychiatr Serv. 1999;50:171–174.CrossRefGoogle ScholarPubMed
18.Malone, RP, Delaney, MA, Luebbert, JF, Cater, J, Campbell, M. A double-blind placebo-controlled study of lithium in hospitalized aggressive children and adolescents with conduct disorder. Arch Gen Psychiatry. 2000;57:649–654.CrossRefGoogle ScholarPubMed
19.Brown, GL, Linnoila, MI. CSF serotonin metabolite (5-HIAA) studies in depression, impulsivity, and violence. J Clin Psychiatry. 1990:51:31–41.Google ScholarPubMed
20.Greenhill, L, Halperin, JM, Abikoff, H. Stimulant medications. J Am Acad Child Adolesc Psychiatry. 1999;38:503–512.CrossRefGoogle ScholarPubMed
21.Zahn, TP, Rapoport, JL, Thompson, CL. Autonomic and behavioral effects of dextroamphetamine and placebo in normal and hyperactive prepubertal boys. J Abnorm Child Psychol. 1980;8:145–160.CrossRefGoogle ScholarPubMed
22.Hare, RD. Psychopathy as a risk factor for violence. Psychiatr Q. 1999;70:181–197.CrossRefGoogle ScholarPubMed
23.Raine, A. Biosocial studies of antisocial and violent behavior in children and adults: a review. J Abnorm Child Psychol. 2002;30:311–326.CrossRefGoogle ScholarPubMed
24.Connor, DF, Ozbayrak, KR, Kusiak, KA, Caponi, AB, Melloni, RH. Combined pharmacotherapy in children and adolescents in a residential treatment center. J Am Acad Child Adolesc Psychiatry. 1997;36:248–254.CrossRefGoogle Scholar
25.Pappadopoulos, E, Jensen, PS, Schur, SB, et al.Real world atypical prescribing practices in public child and adolescent inpatient settings. Schizophr Bull. 2002;28:111–121.CrossRefGoogle Scholar
26.Turgay, A, Binder, C, Snyder, R, Fisman, S. Long-term safety and efficacy of risperidone for the treatment of disruptive behavior disorders in children with subaverage IQs. Pediatrics. 2002;110:e34.CrossRefGoogle ScholarPubMed
27.Snyder, R, Turgay, A, Aman, M, Binder, C, Fisman, S, Carroll, A. Effects of risperidone on conduct and disruptive behavior disorders in children with subaverage IQs. J Am Acad Child Adolesc Psychiatry. 2002;41:1026–1036.CrossRefGoogle ScholarPubMed
28.Aman, MG, De Smedt, G, Derivan, A, Lyons, B, Findling, RL. 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.CrossRefGoogle ScholarPubMed
29.Kaplan, BJ, Sadock, VA, ed. Kaplan & Sadock's Comprehensive Textbook of Psychiatry. 7th ed. New York, NY: Lippincott, Williams and Wilkins; 2000;2235–2531.Google Scholar
30.Schatzberg, A, Debattista, C. Manual Of Clinical Psychopharmacology. 3rd ed. Washington, DC: American Psychiatric Association; 1997.Google Scholar
31.Kutcher, S. Practical Child and Adolescent Psychopharmacology. 1st ed. New York, NY: W.B. Saunders Company; 2002.CrossRefGoogle Scholar
32.Campbell, M, Small, AM, Green, WH, et al.Behavioral efficacy of haloperidol and lithium carbonate. A comparison in hospitalized aggressive children with conduct disorder. Arch Gen Psychiatry. 1984:41:650–656.CrossRefGoogle ScholarPubMed
33.Campbell, M, Adams, PB, Small, AM, et al.Lithium in hospitalized aggressive children with conduct disorder: a double-blind and placebo-controlled study. J Am Acad Child Adolesc Psychiatry. 1995:34:445–453.CrossRefGoogle ScholarPubMed
34.Greenhill, LL, Solomon, M, Pleak, R, Ambrosini, P. Molindone hydrochloride treatment of hospitalized children with conduct disorder. J Clin Psychiatry. 1985;46:30–35.Google ScholarPubMed
35.Klein, RG. Preliminary results: lithium effects in conduct disorders. CME Syllabus and Proceedings Summary presented at: Annual Meeting of the American Psychiatric Association; May 11-16, 1991; New Orleans, La.Google Scholar
36.Klein, RG, Abikoff, H, Klass, E, Ganeles, D, Seese, LM, Pollack, S. Clinical efficacy of methylphenidate in conduct disorder with and without attention deficit hyperactivity disorder. Arch Gen Psychiatry. 1997;54:1073–1080.CrossRefGoogle ScholarPubMed
37.Campbell, M, Silva, RR, Kafantaris, V, et al.Predictors of side effects associated with lithium administration in children. Psychopharm Bulletin. 1991;27:373–380.Google ScholarPubMed
38.Cueva, JE, Overall, JE, Small, AM, Armenteros, JL, Perry, L, Campbell, M. Carbamazepine in aggressive children with conduct disorder: a double-blind and placebo-controlled study. J Am Acad Child Adolesc Psychiatry. 1996;35:480–490.CrossRefGoogle ScholarPubMed
39.Rifkin, A, Karajgi, B, Dicker, R, et al.Lithium treatment of conduct disorders in adolescents. Am J Psychiatry. 1997;154:554–555.Google ScholarPubMed
40.Malone, RP, Bennett, DS, Luebbert, JF, et al.Aggression classification and treatment response. Psychopharmacol Bull. 1998;34:41–45.Google ScholarPubMed
41.Donovan, SJ, Stewart, JW, Nunes, EV, et al.Divalproex treatment for youth with explosive temper and mood liability: a double blind, placebo-controlled crossover design. Am J Psychiatry. 2000;157:818–820.CrossRefGoogle Scholar
42.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.CrossRefGoogle ScholarPubMed
43.Malone, RP, Delaney, MA, Luebbert, JF, Cater, J, Campbell, M. A double-blind placebo-controlled study of lithium in hospitalized aggressive children and adolescents with conduct disorder. Arch Gen Psychiatry. 2000;57:649–654.CrossRefGoogle ScholarPubMed
44.Steiner, H, Petersen, M, Saxena, K, Ford, S, Matthews, Z. A randomized clinical trial of divalproex sodium in conduct disorders. J Clin Psychiatry. In press.Google Scholar
45.Armenteros, JL, Lewis, JE. Citalopram treatment for impulsive aggression in children and adolescents: an open pilot study. J Am Acad Child Adolesc Psychiatry. 2002;41:522–529.CrossRefGoogle ScholarPubMed
46.Hameer, O, Collin, K, Ensom, MH, Lomax, S. Evaluation of droperidol in the acutely agitated child or adolescent. Can J Psychiatry. 2001;46:49–50.CrossRefGoogle ScholarPubMed
47.Buitelaar, JK. Open-label treatment with risperidone of 26 psychiatrically hospitalized children and adolescents with mixed diagnoses and aggressive behavior. J Child Adolesc Psychopharmacol. 2000;10:19–26.CrossRefGoogle ScholarPubMed
48.Joshi, PT, Hamel, L, Joshi, A, Capozzoli, JA. Use of droperidol in hospitalized children. J Am Acad Child Adolesc Psychiatry. 1998;37:228–230.CrossRefGoogle ScholarPubMed
49.Schreier, , Herbert, A. Risperidone for young children with mood disorders and aggressive behavior. J Child Adolesc Psychopharmacol. 1998;8:49–59.CrossRefGoogle ScholarPubMed
50.Donovan, SJ, Susser, ES, Nunes, EV, Stewart, JW, Quitkin, FM, Klein, DF. Divalproex treatment of disruptive adolescents: a report of 10 cases. J Clin Psychiatry. 1997;58:12–15.CrossRefGoogle ScholarPubMed
51.Kemph, JP, DeVane, CL, Levin, GM, Jarecke, R, Miller, RL. Treatment of aggressive children with clonidine: results of an open pilot study. J Am Acad Child Adolesc Psychiatry. 1993;32:577–581.CrossRefGoogle ScholarPubMed
52.Barnett, SR, Dosreis, S, Riddle, MA. The Maryland Youth Practice Improvement Committee for Mental Health. Improving the management of acute aggression in state residential and inpatient psychiatric facilities for youths. J Am Acad Child Adolesc Psychiatry. 2002;41:897–905.CrossRefGoogle ScholarPubMed
53.Bieniek, SA, Ownby, RL, Penalver, A, Dominguez, RA. A double-blind study of lorazepam versus the combination of haloperidol and lorazepam in managing agitation. Pharmacotherapy. 1998;18:57–62.CrossRefGoogle ScholarPubMed
54.Chang, KD, Blasey, C, Ketter, TA, Steiner, H. Family environment of children and adolescents with bipolar parents. Bipolar Disord. 2001;3:73–78.CrossRefGoogle ScholarPubMed
55.Steiner, H, Garcia, IG, Matthews, Z. Posttraumatic stress disorder in incarcerated juvenile delinquents. J Am Acad Child Adolesc Psychiatry. 1997;36:357–365.CrossRefGoogle ScholarPubMed
56.Saxena, K, Silverman, M, Remsing, L, Chang, K, Steiner, H. Predictors of response to divalproex sodium in conduct disorder. Scientific Proceedings of the Annual Meeting of the American Academy of Child and Adolescent Psychiatry. 2002;18:128.Google Scholar
57.Cocarro, EF, Kavoussi, RJ. Fluoxetine and impulsive aggressive behavior in personality-disordered subjects. Archives Gen Psychiatry. 1997;54:1081–1088.CrossRefGoogle Scholar
58.Riddle, MA, Bernstein, GA, Cook, EH, Leonard, HL, March, JS, Swanson, JM. Anxiolytics, adrenergic agents, and naltrexone. J Am Acad Child Adolesc Psychiatry. 1999;38:546–556.CrossRefGoogle ScholarPubMed