Clin Psychopharmacol Neurosci.  2019 Feb;17(1):43-53. 10.9758/cpn.2019.17.1.43.

Clozapine in the Treatment of Aggression in Conduct Disorder in Children and Adolescents: A Randomized, Double-blind, Controlled Trial

Affiliations
  • 1Department of Psychiatry, Hospital Universitario, Universidad Autónoma de Nuevo León, Escuela de Medicina, NL, Mexico. dramyrthalajuarez@yahoo.com
  • 2Unidad Monterrey, Centro de Investigación en Matemáticas CIMAT, Escuela de Medicina, NL, Mexico.
  • 3Department of Psychiatry, Instituto Tecnológicoy de Estudios Superiores de Monterrey ITESM, Escuela de Medicina, NL, Mexico.
  • 4Department of Internal Medicine, Hospital Universitario, Universidad Autónoma de Nuevo León, Escuela de Medicina, NL, Mexico.
  • 5Department of Pediatrics, Hospital Universitario, Universidad Autónoma de Nuevo León, Escuela de Medicina, NL, Mexico.
  • 6Department of Pharmacology, Hospital Universitario, Universidad Autónoma de Nuevo León, Escuela de Medicina, NL, Mexico.
  • 7Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA.

Abstract

OBJECTIVE: This study was conducted to compare the efficacy of clozapine vs. risperidone in the treatment of aggression in conduct disorder in children and adolescents.
METHODS
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.
RESULTS
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 (p=0.039, 0.010, and 0.021). Two subjects from the clozapine group were excluded due to a low neutrophil count at week four.
CONCLUSION
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.

Keyword

Clozapine; Risperidone; Conduct disorder; Child; Adolescent
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