Rajkumar Ravi Philip
Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry 605 006, India.
Biomedicines. 2022 Nov 4;10(11):2818. doi: 10.3390/biomedicines10112818.
Disruptive behaviour disorders (DBDs) in childhood include conduct disorder (CD) and oppositional defiant disorder (ODD). Though psychological therapies are considered to be the first-line treatment for DBDs, many patients require adjunctive pharmacotherapy for the control of specific symptoms, such as aggression. Three prior systematic reviews have examined the evidence for the use of antipsychotics in DBDs and have concluded that their efficacy is marginal and limited by adverse effects. This paper has two objectives: (i) to summarize the findings of existing systematic reviews of antipsychotics for the management of DBDs in children and adolescents (2012-2017), and (ii) to provide an update to these reviews by examining recent clinical trials of antipsychotics in this population, published in the period from 2 January 2017 to 10 October 2022. The PubMed, Scopus and ScienceDirect databases were searched for relevant citations using the search terms "disruptive behaviour disorder", "oppositional defiant disorder", "conduct disorder" and their variants, along with "antipsychotic", "atypical antipsychotic" and the generic names of all currently approved atypical antipsychotics. Six relevant trials were identified during this period, including five randomized controlled trials and one naturalistic open-label trial. These trials were critically evaluated in terms of outcome measures, efficacy and safety. Overall, the data from these trials suggests that of all available antipsychotics, risperidone appears to be effective in the short-term management of DBDs. All available antipsychotics are associated with significant metabolic adverse effects in this population. These results are discussed in the light of global trends towards increasing off-label prescription of antipsychotic medication in children and adolescents and of recent literature on the neuropharmacology of aggression in this patient population. The need for rational, short-term use of these drugs is highlighted, as well as the importance of post-marketing surveillance for long-term or severe adverse events.
儿童期破坏性行为障碍（DBDs）包括品行障碍（CD）和对立违抗障碍（ODD）。尽管心理治疗被认为是DBDs的一线治疗方法，但许多患者需要辅助药物治疗来控制特定症状，如攻击行为。之前有三项系统评价研究了在DBDs中使用抗精神病药物的证据，并得出结论认为其疗效有限且受不良反应限制。本文有两个目标：（i）总结2012 - 2017年期间现有关于抗精神病药物用于治疗儿童和青少年DBDs的系统评价结果，（ii）通过审查2017年1月2日至2022年10月10日期间发表的该人群抗精神病药物近期临床试验，对这些评价进行更新。使用搜索词“破坏性行为障碍”、“对立违抗障碍”、“品行障碍”及其变体，以及“抗精神病药物”、“非典型抗精神病药物”和所有当前批准的非典型抗精神病药物的通用名称，在PubMed、Scopus和ScienceDirect数据库中搜索相关引文。在此期间确定了六项相关试验，包括五项随机对照试验和一项自然主义开放标签试验。对这些试验的结果测量、疗效和安全性进行了严格评估。总体而言，这些试验的数据表明，在所有可用的抗精神病药物中，利培酮似乎对DBDs的短期治疗有效。所有可用的抗精神病药物在该人群中都与显著的代谢不良反应相关。根据儿童和青少年抗精神病药物非标签处方增加的全球趋势以及该患者人群攻击行为神经药理学的近期文献，对这些结果进行了讨论。强调了合理、短期使用这些药物的必要性，以及上市后监测长期或严重不良事件的重要性。
