Co-morbid disruptive behavior disorder and aggression predict functional outcomes
and differential response to risperidone versus divalproex in pharmacotherapy for
pediatric bipolar disorder.
Author(s): West AE, Weinstein SM, Celio CI, Henry D, Pavuluri MN.
Affiliation(s): Department of Psychiatry, University of Illinois, Chicago, Illinois 60608, USA.
awest@psych.uic.edu
Publication date & source: 2011, J Child Adolesc Psychopharmacol. , 21(6):545-53
OBJECTIVE: Co-morbid diagnoses, such as disruptive behavior disorders (DBDs) and
high levels of aggression, are extremely common among youth with pediatric
bipolar disorder (PBD) and may interfere with treatment response; however, they
have rarely been examined as predictors of response to pharmacotherapy. The
current study examines co-morbid DBD and aggression prospectively as predictors
of pharmacotherapy outcome, as well as potential moderators of response to a
specific medication (risperidone vs. divalproex), among children with PBD.
METHODS: Data are from a prospective 6-week double-blind, placebo-controlled,
randomized outpatient medication treatment trial of risperidone versus divalproex
for manic episodes in 65 children 8-18 with PBD. Outcome measures were
administered at pretest, post-test, and weekly during the 6 weeks of treatment.
Mixed-effects regression models were used to examine pharmacotherapy response.
RESULTS: Results indicated that youth with co-morbid DBD experienced greater
improvement in manic symptoms in response to risperidone versus divalproex,
whereas youth with non-co-morbid DBD experienced similar trajectories of symptom
improvement in both medication groups. In addition, the non-DBD group experienced
greater improvement in global functioning over time as compared with youth with
co-morbid-DBD, and this gap increased over the course of treatment. Results also
indicated that high-aggression youth experienced worse global functioning by end
treatment versus low-aggression youth.
CONCLUSIONS: In conclusion, a co-morbid diagnosis of DBD and/or high levels of
aggressive symptoms in youth with PBD may be important clinical predictors of
variation in treatment response to pharmacotherapy. These findings may help
researchers and clinicians develop tailored treatment approaches that optimize
symptom and functional outcomes.
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