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Tratamiento de olanzapina en adolescentes con trastorno disocial grave
Published online by Cambridge University Press: 12 May 2020
Resumen
Las formas más graves de trastorno disocial (TD, conduct disorder) son trastornos sumamente estables y discapacitantes que es muy probable que persistan en el tiempo y evolucionen hacia comportamientos perturbadores o antisociales. Una cuestión crucial en el pronóstico de estas formas de TD es la elevada resistencia a los tratamientos tanto no farmacológicos como farmacológicos, utilizándose con frecuencia los medicamentos antipsicóticos en los casos resistentes al tratamiento. El propósito de este estudio era: (1) explorar la eficacia y la tolerabilidad del tratamiento de olanzapina en adolescentes con TD grave; (2) identificar predictores de la evolución del tratamiento de olanzapina. Este estudio era un trabajo retrospectivo, basado en las historias clínicas de los 23 primeros adolescentes a los que se diagnosticó TD puro o con diagnósticos comórbidos, utilizando una entrevista clínica (K-SADS), y se trató con olanzapina. Todos estos pacientes no respondieron satisfactoriamente a la intervención no farmacológica y a dosis adecuadas de estabilizadores del estado de ánimo (litio, valproato o ambas cosas). La muestra constaba de 16 varones y siete mujeres, 16 pacientes hospitalizados y siete ambulatorios (edad media: 13,6 ± 1,9 años, intervalo: 11-17,2 años), seguidos durante un periodo de 6-12 meses (media 8,8 ± 2,7 meses). Las medidas de evolución incluían la Escala de Agresión Abierta Modificada (MOAS), la Impresión Clinica Global-Mejoría (CGI-I) y la Escala de Evaluación Global Infantil (CGAS). Durante el seguimiento, todos los pacientes participaron en tratamientos no farmacológicos (psicoterapia, terapia familiar o tratamientos de grupo en hospital de día). Al final del seguimiento, se clasificó a 14 de los 23 pacientes (60,9%) como pacientes con respuesta sobre la base de una mejoría de 50% al menos en la MOAS y una puntuación de 1 ó 2 en la CGI-I. Se encontró mejoría significativa en la última observación en las puntuaciones de la MOAS (P < 0,001) y la CGAS (P < 0,001). La dosis de olanzapina fue 8 ± 3,2 mg/día (intervalo 5-20 mg/día). El aumento medio de peso al final del seguimiento fue 4,6 ± 3 kg. Era predictor de una respuesta positiva al tratamiento un tipo impulsivo-afectivo frente a uno controlado-predatorio de agresión. La edad en el comienzo del TD y los trastornos comórbidos no afectaron a la respuesta al tratamiento. Estos hallazgos preliminares indican que la olanzapina puede mejorar el comportamiento en adolescentes con TD grave y resistente al tratamiento y agresión impulsiva.
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References
Bibliografía
Aman, MGDe Smedt, GDerivan, ALyons, BFindling, RLRisperidone 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: 1337–46.CrossRefGoogle Scholar
Bassarath, L. Medication strategies in childhood aggression: a review. Can J Psychiatry 2003;48:367–73.CrossRefGoogle ScholarPubMed
Biederman, JFaraone, SVChu, MPWozniak, J. Further evidence of a bidirectional overlap between juvenile mania and conduct disorder in children. J Am Acad Child Adolesc Psychiatry 1999;38:468–76.CrossRefGoogle ScholarPubMed
Biederman, JMick, EWozniak, JMonuteaux, MCGaldo, MFaraone, SV. Can a subtype of conduct disorder linked to bipolar disorder be identified? Integration of findings from the Massachussetts General Hospital Pediatric Psychopharmacology Research Program. Biol Psychiatry 2003;53:938–44.CrossRefGoogle Scholar
Burke, JDLoeber, RBirmaher, B. Oppositional defiant disorder and conduct disorder: a review of the post 10 years, Part II. J Am Acad Child Adolesc Psychiatry 2002;41:1275–93.CrossRefGoogle Scholar
Campbell, MSmall, AMGreen, WHJennings, SJPerry, RBennet, WG, et al. Behavioral efficacy of haloperidol and lithium carbonate: a comparison in hospitalized aggressive children with conduct disorder. Arch Gen Psychiatry 1984;41:650–0.CrossRefGoogle ScholarPubMed
Campbell, MAdams, PBSmall, AMKafantaris, VSilva, RRShell, J, et al. Lithium in hospitalized aggressive children with conduct disorder: a double-blind and placebo-controlled study. J Am Acad Child Adolesc Psychiatry 1995;34:445–53CrossRefGoogle ScholarPubMed
Campbell, MArmenteros, JLMalone, RPAdams, PBEisenberg, ZWOverall, J. Neuroleptic-related dyskinesias in artistic children: a prospective, longitudinal study. J Am Acad Child Adolesc Psychiatry 1997;36:835–13.CrossRefGoogle Scholar
Capaldi, DM. The co-occurrence of conduct problems and depressive symptoms in early adolescent boys, II: a 2-year follow-up at grade 8. Dev Psychopathol 1992;4:125–44.CrossRefGoogle Scholar
Carlson, GALavelle, JBromet, EJ. Medication treatment in adolescents vs. adults with psychotic mania. J Child Adolesc Psychopharmacol 1999;9:221–31.CrossRefGoogle ScholarPubMed
Carlson, AGBromet, EJSievers, S. Phenomenology and outcome of subjects with early- and adult-onset psychotic mania. Am J Psychiatry 2000;157:213–9.CrossRefGoogle ScholarPubMed
Cohen, PCohen, JBrook, J. An epidemiological study of disorders in lote childhood and adolescence, II: persistence of the disorders. J Child Psychol Psychiatry 1993;34:869–77.CrossRefGoogle Scholar
Connor, DF. Beta blockers for aggression: a review of the pediatric experience. J Child Adolesc Psychopharmacol 1993;3:99–114.CrossRefGoogle Scholar
Connor, DFFletcher, KEWood, JS. Neuroleptic-related dyskinesias in children and adolescents. J Clin Psychiatry 2001;62:967–74.CrossRefGoogle ScholarPubMed
Conoor, DFGlatt, SJLopez, IDJackson, DMelloni, RHPsychopharmacology and aggression, I: a meta-analysis of stimulants effects on overt/covert aggression-related behaviors in ADHD. J Am Acad Child Adolesc Psychiatry 2002;41:253–61.CrossRefGoogle Scholar
Cueva, JEOverall, JESmall, AMArmenteros, JLPerry, RCampbell, M. Carbamazepine in aggressive children with conduct disorder: a double blind and placebo controlled study. J Am Acad Child Adolesc Psychiatry 1996;35:480–90.CrossRefGoogle ScholarPubMed
Czobor, PVolavka, JSheitman, BLindenmayer, JPCitrome, LMcEvoy, J, et al. Antipsychotic-induced weight gain and therapeutic response: a differential association. J Clin Psychopharmacol 2002;22: 244–51.CrossRefGoogle ScholarPubMed
Donovan, SStewart, JNunes, EQuitkin, FMParides, MDaniel, W, et al. Divalproex treatment for youth with explosive temper and mood lability: a double blind placebo controlled crossover design. Am J Psychiatry 2000;57:818–20.CrossRefGoogle Scholar
Findling, RL. Open-label treatment of comorbid depression and attentional disorders with co-administration of serotonin reuptake inhibitors and psychostimulants in children, adolescents, and adults: a case series. J Child Adolesc Psychopharmacol 1996;6:165–75.CrossRefGoogle ScholarPubMed
Findling, RLMcNamara, NKBranicky, LASchluchter, MDLemon, EBlumer, JL. A double blind pilot study of risperidone in the treatment of conduct disorder. J Am Acad Child Adolesc Psychiatry 2000;38:509–16.CrossRefGoogle Scholar
Frazier, JABiederman, JTohen, MFeldman, PDJacobs, TGRote, MA, et al. A prospective, open-label treatment trial for olanzapine monotherapy in children and adolescents with bipolar disorder. J Child Adolesc Psychopharmacol 2001;11:239–50.CrossRefGoogle ScholarPubMed
Gerardin, PCohen, DMazet, PFlament, MF. Drug treatment of conduct disorder in young people. Eur Neuropsychopharmacol 2002; 12:361–70.CrossRefGoogle ScholarPubMed
Guy, W. ECDEU Assessment Manual for psychopharmacology, Revised. Rockville, MD: US Department of Health, Education and Welfare; 1976.Google Scholar
Hollingshead, AB. Two Factor Index of social position. Unpublished manuscript. New Haven CT: Yale University, Department of Sociology; 1957.Google Scholar
Kafantaris, VCampbell, MPadron-Gayol, MVSmall, AMLocascio, JJRosenberg, CR. Carbamazepine in hospitalized aggressive conduct disorder children: an upen pilot study. Psychopharmacol Bull 1992;28:193–9.Google Scholar
Kaufman, JBimmaher, BBrent, DRao, UFlynn, CMoreci, P, 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: 980–8.CrossRefGoogle ScholarPubMed
Kay, SRWolkenfeld, FMurrill, LM. Profiles of aggression among psychiatric patients. I. Nature and prevalence. J Nerv Ment Dis 1988; 176:539–46.CrossRefGoogle ScholarPubMed
Kazdin, AE. Treatment for aggressive and antisocial children. Child Adolesc Psychiatr Clin N Am 2000;9:841–58.CrossRefGoogle ScholarPubMed
Kemph, JPDeVane, CLLevin, CMJarecke, RMiller, RL. Treatment of aggressive children with clonidine: results of an upen pilot study. J Am Acad Child Adolesc Psychiatry 1993;32:577–81.CrossRefGoogle Scholar
Klein, RGAbikoff, HKlass, EGaneles, DSeese, LMPollack, S. Clinical efficacy of methylphenidate in conduct disorder with and without attention deficit hyperactivity disorder. Arch Gen Psychiatry 1997;54:1073–80.CrossRefGoogle ScholarPubMed
Kovacs, MPollock, M. Bipolar disorder and comorbid conduct disorder in childhood and adolescence. J Am Acad Child Adolesc Psychiatry 1995;34:715–23.CrossRefGoogle ScholarPubMed
Lahey, BBWaldman, IDMcBumett, K. The development of antisocial behavior: an integrative causal model. J Child Psychol Psychiatry 1999;40:669–82.CrossRefGoogle Scholar
Loeber, RBurke, JDLahey, BBWinters, AZera, M. Oppositional defiant and conduct disorder: a review of the post 10 years, Part I. J Am Acad Child Adolesc Psychiatry 2000;39:1468–84.CrossRefGoogle Scholar
Malone, RPLuebbert, JFDelaney, MAAdams, PBEisenberg, ZWOverall, JE. Nonpharmacological response in hospitalized children with conduct disorder. J Am Acad Child Adolesc Psychiatry 1997;36: 242–7.CrossRefGoogle ScholarPubMed
Malone, RPBennett, DSLuebbert, JFRowan, ABBiesecker, KABlaney, BL, et al. Aggression: classification and treatment response. Psychopharmacol Bull 1998;34:41–5.Google ScholarPubMed
Malone, RPDelaney, MASLuebbert, JFCater, JCampbell, M. A double blind, placebo-controlled study of lithium in hospitalized aggressive children and adolescents with conduct disorder. Arch Gen Psychiatry 2000;57:649–54.CrossRefGoogle ScholarPubMed
Masi, GToni, CPerugi, GTravierso, MCMillepiedi, SMucci, M, et al. Extemalizing disorders in consecutively referred children and adolescents with bipolar disorder. Compr Psychiatry 2003;44:184–9.CrossRefGoogle Scholar
Masi, GCosenza, AMucci, MBrovedani, P. A 3-year naturalistic study of 53 preschool children with pervasive developmental disorder treated with risperidone. J Clin Psychiatry 2003;64:1039–47.CrossRefGoogle ScholarPubMed
Masi, GPerugi, GToni, CMillepiedi, SMucci, MBertini, N, et al. Predictors of treatment non-response on bipolar children and adolescents with manic or mixed episodes. J Child Adolesc Psychopharmacol 2004;14:395–404.CrossRefGoogle ScholarPubMed
Pappadopulos, EMacintyre, JCCrismon, MLDerivan, AFindling, RLMalone, RP, 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
Rifkin, AKarajgi, BDicker, RPeri, EBoppana, VHasan, N, et al. Lithium treatment of conduct disorder in adolescents. Am J Psychiatry 1997;154:554–5.Google ScholarPubMed
Schur, SBSikich, LFindling, RLMalone, RPCrismon, MLDerivan, A, et al. Treatment recommendations for the use of antipsychotics for aggressive youth (TRAAY). Part I. J Am Acad Child Adolesc Psychiatry 2003;42:132–44.CrossRefGoogle ScholarPubMed
Shaffer, DGould, MBrasic, JAmbrosini, PFisher, PBird, H, et al. Children's Global Assessment Scale (CGAS). Arch Gen Psychiatry 1983;40:1228–31.CrossRefGoogle Scholar
Snyder, RTurgay, AAman, MBinder, CFisman, SCarroll, A. 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;41:1026–36.CrossRefGoogle Scholar
Soderstrom, HRastam, MGilberg, C. A clinical case series of six extremely aggressive youths treated with olanzapine. Eur Child Adolesc Psychiatry 2002;11:138–41.CrossRefGoogle ScholarPubMed
Stein, DJSimeon, DFrenke, MIslam, MNHollander, E. An upen trial of valproate in borderline personality disorder. J Clin Psychiatry 1995;56:506–10.Google Scholar
Stigler, KAPotenza, MNPosey, DJMcDougle, CJ. Weight gain associated with atypical antypsychotic use in children and adolescents: prevalence, clinical relevance, and management. Paediatr Drugs 2004;6:33–44.CrossRefGoogle Scholar
Tohen, MGoldberg, JFGonzalez-Pinto, Arrillaga AMAzorin, JMVieta, EHardly-Bayle, MC, et al. A 12-week, double-blind comparison of olanzapine vs. haloperidol in the treatment of acute mania. Arch Gen Psychiatry 2003;60:1218–26.CrossRefGoogle ScholarPubMed
Vitiello, BStoff, DM. Subtypes of aggression and their relevance into child psychiatry. J Am Acad Child Adolesc Psychiatry 1997;36:307- 15.CrossRefGoogle ScholarPubMed
Vitiello, BBehar, DHunt, JStoff, DRicciuti, A. Subtyping aggression in children and adolescents. J Neuropsychiatry Clin Neurosci 1990;2: 189–92.Google ScholarPubMed
Yudofsky, SCSilver, JMJackson, WEndicott, JWilliams, D. The Overt Aggression Scale for the objective rating of verbal and physical aggression. Am J Psychiatry 1986;143:35–9.Google ScholarPubMed