Juárez-Treviño Myrthala, Esquivel Antonio Costilla, Isida Lilia Marytza Leal, Delgado Dionicio Ángel Galarza, de la O Cavazos Manuel E, Ocañas Lourdes Garza, Sepúlveda Rosalinda Sepúlveda
Department of Psychiatry, Hospital Universitario, Universidad Autónoma de Nuevo León, Mexico.
Unidad Monterrey, Centro de Investigación en Matemáticas CIMAT, Mexico.
Clin Psychopharmacol Neurosci. 2019 Feb 28;17(1):43-53. doi: 10.9758/cpn.2019.17.1.43.
This study was conducted to compare the efficacy of clozapine vs. risperidone in the treatment of aggression in conduct disorder in children and adolescents.
Twenty-four children with conduct disorder aged 6 to 16 years were randomized in a prospective, double-blind trial into two groups to receive clozapine or risperidone for 16 weeks. The Modified Overt Aggression Scale score was used as the primary outcome of the study. Secondary outcomes were Child Behavior Checklist (CBCL) externalization (CBCL-E) and internalization factors; Aggression, Hyperactivity and Delinquency subscales of CBCL-E, Child Global Assessment Scale (CGAS), Barnes Akathisia Rating Scale, and Simpson-Angus Scale.
Both antipsychotics were similarly effective in the primary outcome and in most of the secondary ones. Clozapine was more effective in CBCL-E, the delinquency subscale and the CGAS scores than risperidone ( =0.039, 0.010, and 0.021). Two subjects from the clozapine group were excluded due to a low neutrophil count at week four.
Clozapine and risperidone are effective for short-term treatment of aggression in children and adolescents with conduct disorder. Clozapine was more effective than risperidone in conduct externalization factors, delinquency trait and global functioning in children and adolescents. Stronger efficacy of clozapine should be investigated in larger sample sizes using pharmacogenomic studies. White blood cell counts need to be monitored when prescribing clozapine.
本研究旨在比较氯氮平与利培酮治疗儿童和青少年品行障碍中攻击行为的疗效。
24名年龄在6至16岁的品行障碍儿童在前瞻性双盲试验中被随机分为两组，分别接受氯氮平或利培酮治疗16周。改良外显攻击量表评分作为研究的主要结局。次要结局包括儿童行为量表（CBCL）外化（CBCL-E）和内化因子；CBCL-E的攻击、多动和违纪分量表、儿童总体评估量表（CGAS）、巴恩斯静坐不能评定量表和辛普森-安格斯量表。
两种抗精神病药物在主要结局和大多数次要结局方面同样有效。氯氮平在CBCL-E、违纪分量表和CGAS评分方面比利培酮更有效（P = 0.039、0.010和0.021）。氯氮平组有两名受试者因第4周时中性粒细胞计数低而被排除。
氯氮平和利培酮对儿童和青少年品行障碍中的攻击行为短期治疗有效。氯氮平在儿童和青少年的品行外化因子、违纪特质和整体功能方面比利培酮更有效。应使用药物基因组学研究在更大样本量中研究氯氮平更强的疗效。开具氯氮平时需要监测白细胞计数。
