Treatment recommendations for the use of antipsychotics for aggressive youth (TRAAY). Part I: a review.
OBJECTIVE
To review the evidence for the safety and efficacy of nonpharmacological and pharmacological treatments for aggression in children and adolescents.


METHODS
and searches (1990-present) were conducted for double-blind, placebo-controlled studies of atypical antipsychotics for aggression and for literature on the use of other pharmacological agents and psychosocial interventions for aggression. Case reports and adult literature regarding the safety of atypical antipsychotics were used where controlled data for youth were lacking.


RESULTS
Controlled data on the treatment of aggression in youth is scarce. Psychosocial interventions may be effective alone or in combination with pharmacological treatments. Psychotropic agents (e.g., stimulants, mood stabilizers, beta-blockers) have also been shown to have limited efficacy in reducing aggression. Antipsychotics, particularly the atypical antipsychotics, show substantial efficacy in the treatment of aggression in selected pediatric populations. Atypical antipsychotics are generally associated with fewer extrapyramidal symptoms than are typical antipsychotics.


CONCLUSIONS
Psychosocial interventions and atypical antipsychotics are promising treatments for aggression in youth. Double-blind studies should examine the safety and efficacy of atypical antipsychotics compared to each other and to medications from other classes, the efficacy of specific medications for different subtypes of aggression, combining various psychotropic medications, optimal dosages, and long-term safety.
Schur
Sarah B
SB
Center for the Advancement of Children's Mental Health, Columbia University/New York State Psychiatric Institute, NY 10032, USA.
Sikich
Lin
L
Findling
Robert L
RL
Malone
Richard P
RP
Crismon
M Lynn
ML
Derivan
Albert
A
Macintyre Ii
James C
JC
Pappadopulos
Elizabeth
E
Greenhill
Laurence
L
Schooler
Nina
N
Van Orden
Kimberly
K
Jensen
Peter S
PS
D000293:Adolescent; D000374:Aggression / Q000523:psychology*; D002986:Clinical Trials as Topic; D006801:Humans; D011618:Psychotic Disorders / Q000188:drug therapy* / Q000523:psychology*