Masi Gabriele, Milone Annarita, Canepa Giovanna, Millepiedi Stefania, Mucci Maria, Muratori Filippo
IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Via dei Giacinti 2, 56018 Calambrone (Pisa), Italy.
Eur Psychiatry. 2006 Jan;21(1):51-7. doi: 10.1016/j.eurpsy.2004.11.010.
The most severe forms of conduct disorder (CD) are highly stable and disabling disorders, more likely to persist in time and to evolve into disruptive or antisocial behaviors. One crucial issue in the prognosis of these forms of CD is the high resistance to both non-pharmacological and pharmacological treatments, with antipsychotic drugs being frequently used in refractory cases. Aim of this study was: (1) to explore efficacy and tolerability of olanzapine treatment in adolescents with severe CD; (2) to identify predictors of olanzapine treatment outcome. This was a retrospective study, based on clinical records of the first 23 adolescents diagnosed as having a CD, diagnosed with a clinical interview (K-SADS), either pure or with comorbid diagnoses, and treated with olanzapine. All these patients did not respond satisfactorily to non-pharmacological intervention and to adequate dosages of mood stabilizers (lithium and/or valproate). The sample consisted of 16 males and seven females, 16 inpatients and seven outpatients (mean age 13.6 +/- 1.9 years, range 11-17.2 years), followed-up for a period ranging from 6 to 12 months (mean 8.8 +/- 2.7 months). Outcome measures included the Modified Overt Aggression Scale (MOAS), Clinical Global Impression-Improvement (CGI-I) and Children Global Assessment Scale (CGAS). During the follow-up, all patients were involved in non-pharmacological treatments (psychotherapy, family therapy, or day-hospital group treatments). Based on both an improvement of at least 50% at MOAS and a score 1 or 2 at CGI-I, 14 out of 23 patients (60.9%) were classified as responders at the end of the follow-up. Significant improvement at the last observation was found in MOAS (P < 0.001) and CGAS (P < 0.001) scores. Olanzapine dosage was 8 +/- 3.2 mg/day (range 5-20 mg/day). Mean weight gain at the end of the follow-up was 4.6 +/- 3 kg. The predictors of a positive treatment response was an impulsive-affective versus controlled-predatory type of aggression. Age at onset of CD and comorbid disorders did not affect treatment response. These preliminary findings suggest that olanzapine may improve behavior in adolescents with severe and treatment-refractory CD and impulsive aggression.
品行障碍（CD）最严重的形式是高度稳定且致残的疾病，更有可能随时间持续存在并演变为破坏性行为或反社会行为。这些严重形式的CD预后的一个关键问题是对非药物和药物治疗均具有高抗性，抗精神病药物常用于难治性病例。本研究的目的是：（1）探讨奥氮平治疗重度CD青少年的疗效和耐受性；（2）确定奥氮平治疗结果的预测因素。这是一项回顾性研究，基于最初23例被诊断为患有CD的青少年的临床记录，通过临床访谈（K-SADS）进行诊断，包括单纯型或合并其他诊断，并接受奥氮平治疗。所有这些患者对非药物干预和适当剂量的心境稳定剂（锂盐和/或丙戊酸盐）均无满意反应。样本包括16名男性和7名女性，16名住院患者和7名门诊患者（平均年龄13.6±1.9岁，范围11 - 17.2岁），随访时间为6至12个月（平均8.8±2.7个月）。结果测量包括改良外显攻击量表（MOAS）、临床总体印象改善量表（CGI-I）和儿童总体评定量表（CGAS）。在随访期间，所有患者均接受非药物治疗（心理治疗、家庭治疗或日间医院团体治疗）。基于MOAS至少改善50%且CGI-I评分为1或2，23例患者中有14例（60.9%）在随访结束时被分类为有反应者。在最后一次观察中，发现MOAS（P < 0.001）和CGAS（P < 0.001）评分有显著改善。奥氮平剂量为8±3.2mg/天（范围5 - 20mg/天）。随访结束时平均体重增加4.6±3kg。积极治疗反应的预测因素是冲动情感型与控制掠夺型攻击。CD起病年龄和共病情况不影响治疗反应。这些初步发现表明，奥氮平可能改善重度且难治性CD及冲动攻击青少年的行为。
