Hostname: page-component-cd9895bd7-mkpzs Total loading time: 0 Render date: 2024-12-18T10:58:13.509Z Has data issue: false hasContentIssue false
  • English
  • Français

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
Get access

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

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.)

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