Treatment Recommendations for the Use of Antipsychotics for Aggressive Youth (TRAAY) Part II

Pappadopulos, Elizabeth; MacIntyre, James C.; Crismon, M. Lynn; Findling, Robert L.; Malone, Richard P.; Derivan, Albert T.; Schooler, Nina R.; Sikich, Lin; Greenhill, Laurence L.; Schur, Sarah B.; Felton, Chip J.; Kranzler, Harvey N.; Rube, David M.; Sverd, Jeffrey; Finnerty, Molly; Ketner, Scott; Siennick, Sonja E.; Jensen, P.S.

doi:10.1176/foc.2.4.608

Cited by 20 publications

(40 citation statements)

References 83 publications

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“…13,16 At the same time, the first medication used should be directed to the primary diagnosis, and only one drug should be used whenever possible. In the case of nonsuccess and when there are risks to the patients or the people that live with them, the treatment should include approaches directed to the aggressive behavior specifically.…”

Section: Resultsmentioning

confidence: 99%

“…22 The use of AAP should be seen as a first tool to control aggression when non-pharmacological approaches fail. 13 Several studies have compared the use of AAP and typical antipsychotics (TAP) in adolescents and young individuals and found that AAP should be the first choice because they have fewer side effects and lower risks of tardive dyskinesia, neuroleptic malignant syndrome, cognitive impairments and extrapyramidal symptoms (EPS), [23][24][25] was recommended, and its use should be constantly monitored because of the risks of metabolic and hormonal disorders and weight gain. 26 Studies have not found differences in the response to treatment between different AAP, and the choice of a specific drug should be based on patient tolerability and adverse events, the most common of which are weight gain, drowsiness, EPS and hyperprolactinemia.…”

Section: Resultsmentioning

confidence: 99%

“…Data about ideal doses to control aggression are not available for other AAP ( Table 2). 13 Studies about AAP are still limited, and, therefore, special attention should be paid to possible adverse events and interactions with other medications. Still according to the TRAAY Part II recommendations, vital signs, weight, prolactin levels and metabolic changes should be constantly monitored, and ECG should be used to monitor patients at regular intervals during dose adjustment, because cardiac changes are dosedependent.…”

Section: Resultsmentioning

confidence: 99%

“…Still according to the TRAAY Part II recommendations, vital signs, weight, prolactin levels and metabolic changes should be constantly monitored, and ECG should be used to monitor patients at regular intervals during dose adjustment, because cardiac changes are dosedependent. 13,32 In the analysis of metabolic changes (weight gain, risk of diabetes and dyslipidemia), studies with adults found that there are differences between the several AAP medications, although results are still relatively discordant, according to Table 3. 26…”

Section: Resultsmentioning

confidence: 99%

“…Other drugs used were anticonvulsants, lithium, psychostimulants, selective serotonin reuptake inhibitors (SSRI), anxiolytics, alpha-agonists, beta-blockers and other sedative drugs. 13 This study reviewed the scientific literature to analyze studies about pharmacological treatments using AAP for impulsive and affective aggression in children and adolescents, regardless of their underlying disease and the different treatments of this symptom, and to describe results and possible limitations. Moreover, at the end of the review, the authors make clinical suggestions that may be useful for healthcare professionals involved in providing mental health care to children and adolescents.…”

Section: Introductionmentioning

confidence: 99%

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Atypical antipsychotics in the treatment of pathological aggression in children and adolescents: literature review and clinical recommendations

Teixeira

Jacintho

Celeri

et al. 2013

Trends Psychiatry Psychother.

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Objective: To review the literature about the use of atypical antipsychotics in the treatment of pathological aggression in children and adolescents. Method: The databases MEDLINE, SciELO, and LILACS were searched for publications in Portuguese or English from 1992 to August 2011 using the following keywords: mental disease, child, adolescent, treatment, atypical antipsychotic, aggressive behavior, aggression, and violent behavior. Results: Sixty-seven studies of good methodological quality and clinical interest and relevance were identified. Studies including children and adolescents were relatively limited, because few atypical antipsychotics have been approved by the Food and Drug Administration (FDA). All the medications included in this review (risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole and clozapine) have some effectiveness in treating aggression in children and adolescents, and choices should be based on clinical indications and side effects. Conclusions: There are few studies about the effectiveness and safety of atypical antipsychotics for the pediatric population, and further randomized controlled studies with larger groups of patients and more diagnostic categories, such as severe conduct disorder and oppositional defiant disorder, should be conducted to confirm the results reported up to date and to evaluate the impact of long-term use. Keywords: Aggression, violence, atypical antipsychotics, behavioral disorders, children, adolescents. ResumoObjetivo: Realizar uma revisão sistemática da literatura científica sobre o uso de antipsicóticos atípicos (APAs) no tratamento da agressividade patológica em crianças e adolescentes. Método: Foi realizada busca eletrônica nas bases de dados MEDLINE, SciELO e LILACS, de 1992 a agosto 2011, considerando artigos publicados em língua inglesa e portuguesa. Foram utilizadas associações das seguintes expressões: mental disease, child, adolescent, treatment, atypical antipsychotic, aggressive behaviour, aggression e violent behavior. Resultados: Foram identificados 67 artigos de boa qualidade metodológica, de relevância e interesse clínico para o tema em foco. De modo geral, os estudos são relativamente limitados para esta faixa etária, resultado do fato de poucos APAs terem sido aprovados pela Food and Drug Administration (FDA). Dentre as medicações consideradas nesta revisão (risperidona, olanzapina, quetiapina, ziprazidona, aripiprazol e clozapina), todas elas podem ter alguma efetividade no tratamento da agressividade em crianças e adolescentes, ficando a escolha baseada na indicação clínica e perfil de efeitos colaterais. Conclusão: O número ainda limitado de estudos acerca da efetividade e segurança na população pediátrica demanda pesquisas futuras com grupos maiores de pacientes e com mais categorias diagnósticas (como, por exemplo, as formas graves de transtorno de conduta e transtorno desafiador de oposição), desenhadas de forma randomizada e controlada. Assim poderão ser confirmados os achados até o momento e o impacto do uso em lo...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Atypical antipsychotics in the treatment of pathological aggression in children and adolescents: literature review and clinical recommendations

Teixeira

Jacintho

Celeri

et al. 2013

Trends Psychiatry Psychother.

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National Trends in the Outpatient Treatment of Children and Adolescents With Antipsychotic Drugs

Olfson¹,

Blanco²,

Liu³

et al. 2006

Arch Gen Psychiatry

549

341

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National Trends in the Outpatient Diagnosis and Treatment of Bipolar Disorder in Youth

Moreno

Laje²,

Blanco³

et al. 2007

Arch Gen Psychiatry

607

331

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Although bipolar disorder may have its onset during childhood, little is known about national trends in the diagnosis and management of bipolar disorder in young people.Objectives: To present national trends in outpatient visits with a diagnosis of bipolar disorder and to compare the treatment provided to youth and adults during those visits.Design: We compare rates of growth between 1994-1995 and 2002-2003 in visits with a bipolar disorder diagnosis by individuals aged 0 to 19 years vs those aged 20 years or older. For the period of 1999 to 2003, we also compare demographic, clinical, and treatment characteristics of youth and adult bipolar disorder visits.Setting: Outpatient visits to physicians in office-based practice.Participants: Patient visits from the National Ambulatory Medical Care Survey (1999)(2000)(2001)(2002)(2003) with a bipolar disorder diagnosis (n = 962).Main Outcome Measures: Visits with a diagnosis of bipolar disorder by youth (aged 0-19 years) and by adults (aged Ն20 years). Results:The estimated annual number of youth office-based visits with a diagnosis of bipolar disorder increased from 25 (1994)(1995) to 1003 (2002-2003) visits per 100 000 population, and adult visits with a diagnosis of bipolar disorder increased from 905 to 1679 visits per 100 000 population during this period. In 1999 to 2003, most youth bipolar disorder visits were by males (66.5%), whereas most adult bipolar disorder visits were by females (67.6%); youth were more likely than adults to receive a comorbid diagnosis of attention-deficit/hyperactivity disorder (32.2% vs 3.0%, respectively; P Ͻ .001); and most youth (90.6%) and adults (86.4%) received a psychotropic medication during bipolar disorder visits, with comparable rates of mood stabilizers, antipsychotics, and antidepressants prescribed for both age groups.Conclusions: There has been a recent rapid increase in the diagnosis of youth bipolar disorder in office-based medical settings. This increase highlights a need for clinical epidemiological reliability studies to determine the accuracy of clinical diagnoses of child and adolescent bipolar disorder in community practice.

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Treatment Recommendations for the Use of Antipsychotics for Aggressive Youth (TRAAY) Part II

Cited by 20 publications

References 83 publications

Atypical antipsychotics in the treatment of pathological aggression in children and adolescents: literature review and clinical recommendations

Atypical antipsychotics in the treatment of pathological aggression in children and adolescents: literature review and clinical recommendations

National Trends in the Outpatient Treatment of Children and Adolescents With Antipsychotic Drugs

National Trends in the Outpatient Diagnosis and Treatment of Bipolar Disorder in Youth

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