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

• Juárez-Treviño M
• Esquivel A
• Isida LM
• Delgado DA
• de la O Cavazos ME
• Ocañas LG
• Sepúlveda RS

• KMID: 2441632
• DOI: http://doi.org/10.9758/cpn.2019.17.1.43

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

MeSH Terms

Adolescent*
Aggression*
Antipsychotic Agents
Checklist
Child Behavior
Child*
Clozapine*
Conduct Disorder*
Humans
Leukocyte Count
Neutrophils
Prospective Studies
Psychomotor Agitation
Risperidone
Sample Size
Antipsychotic Agents
Clozapine
Risperidone