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Lithium May Address Aggression in Children with Conduct Disorder: Presented at AACAP

By Paula Moyer
Special to DG News

SAN FRANCISCO, CA -- October 28, 2002 -- Treatment with lithium is effective in reducing aggressive behaviour in children with conduct disorder, according to Dr. Philip P. Malone, a psychiatrist at M.C.P. Hahnemann University, in Philadelphia, Pennsylvania, United States.

"We found lithium to be more effective than placebo in reducing aggression in children 10 to 17 years old with conduct disorder," said Dr. Malone. "Our initial review was of an inpatient setting, and those findings were similar to an outpatient study that is ongoing."

Dr. Malone, who presented the findings here October 25 at the 49^th annual meeting of the American Academy of Child and Adolescent Psychiatry, noted that studying medication effects on overt aggression has certain challenges.

He noted that there are several challenges involved in assessing aggression, a behaviour that is rarely observed directly and may have different subtypes, including reactive and proactive aggression. They conducted a retrospective analysis of a recently completed study of hospitalised children with conduct disorder and compared these findings from an ongoing outpatient study.

The investigators found that they could measure aggression in both inpatient and outpatient settings, and the treatment response may be related to aggression subtype. Their findings also showed that lithium has potential as a treatment for serious aggression, he said.

In the inpatient setting, the investigators followed 86 hospitalised children, 74 boys and12 girls, who averaged 12.8 years. Of the 86 enrolled, 40 completed the study; these patients were randomised to either lithium or placebo. The investigators excluded children who had comorbid anxiety disorders.

The lithium doses ranged from 900 mg to 2,400 mg daily, with a mean daily dose of 1425 mg. The adverse effects reported were nausea, vomiting, and urinary frequency. The investigators employed both global and specific measures of aggression, and found that lithium was effective when both measures were used. Additionally, they found that patients' response to treatment may be related both to environment and to the subtype of aggression.

"One of the challenges in measuring response to treatment in aggression studies is that patients typically become less aggressive when admitted to the psychiatric unit of a hospital," said Dr. Malone. "Therefore, investigators can inadvertently view a hospitalisation-related drop in aggression as medication-induced."

For this reason, he advocates waiting a few days after admitting an aggressive patient before giving medication that targets the aggression. In this study, the placebo group had a decrease in aggression that eventually reached a plateau, while the treatment group had a continuous decrease.

A second ongoing double-blind placebo-controlled study of lithium is ongoing. In this case, Dr. Malone and colleagues measured aggression by independently interviewing parents and children. The investigators used the Aggression Questionnaire and Overt Aggression Scale (OAS). Among the 77 pairs of parents and children, the investigators found that the parents and children showed substantial agreement for the Aggression Against Others scale of the OAS (r=0.61).

"The agreement between mother and child on this measurement is unusual," said Dr. Malone. "Often the mother observes the aggressive behaviour and the child denies it. One of the findings of interest to us will be adherence, because many families coping with an aggressive child have difficulties organizing a medication regimen."

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