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Tratamiento de olanzapina en adolescentes con trastorno disocial grave

Published online by Cambridge University Press:  12 May 2020

Gabriele Masi ,
Annarita Milone ,
Giovanna Canepa ,
Stefania Millepiedi ,
Maria Mucci  and
Filippo Muratori
Gabriele Masi
Affiliation:
HIRCCS Stella Maris, Instituto Científico de Neurología y Psiquiatría Infantil. Via dei Giacinti 2, 56018, Calambrone (Pisa), Italia
Annarita Milone
Affiliation:
HIRCCS Stella Maris, Instituto Científico de Neurología y Psiquiatría Infantil. Via dei Giacinti 2, 56018, Calambrone (Pisa), Italia
Giovanna Canepa
Affiliation:
HIRCCS Stella Maris, Instituto Científico de Neurología y Psiquiatría Infantil. Via dei Giacinti 2, 56018, Calambrone (Pisa), Italia
Stefania Millepiedi
Affiliation:
HIRCCS Stella Maris, Instituto Científico de Neurología y Psiquiatría Infantil. Via dei Giacinti 2, 56018, Calambrone (Pisa), Italia
Maria Mucci
Affiliation:
HIRCCS Stella Maris, Instituto Científico de Neurología y Psiquiatría Infantil. Via dei Giacinti 2, 56018, Calambrone (Pisa), Italia
Filippo Muratori
Affiliation:
HIRCCS Stella Maris, Instituto Científico de Neurología y Psiquiatría Infantil. Via dei Giacinti 2, 56018, Calambrone (Pisa), Italia
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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.

Keywords

OlanzapinaAdolescentesTrastorno disocialAgresión
Type
Original
Information
European Psychiatry (Ed. Española) , Volume 13 , Issue 8 , November 2006 , pp. 401 - 408
Copyright
Copyright © European Psychiatric Association 2006

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