title: Impulsive aggression with irritability and responsive to divalproex: a pediatric bipolar spectrum disorder phenotype?
abstract: BACKGROUND
  The objective of this retrospective chart review was to evaluate the phenomenology and response to divalproex in a sub-population of children admitted to an inpatient setting with severe impairing symptoms of irritability and aggression. In addition, we examined whether the symptomatology of this group was consistent with a pediatric divalproex-responsive bipolar spectrum disorder.
  
  
  METHODS
  The charts of 46 child and adolescent patients with prominent impulsive aggression with irritability admitted to a crisis stabilization center were assessed retrospectively. Impulsive aggressive symptoms were assessed for admission and discharge severity by two clinicians using the Overt Aggression Scale (OAS) and the Anger-Hostility Subscale of the SCL-90 (SCL-A), with overall functioning changes assessed using the Children's Global Assessment Scale (C-GAS).
  
  
  RESULTS
  Statistically significant improvements were obtained for the group in the C-GAS, with significant decreases in the OAS and the SCL-A scores at discharge, following a maximal 14-day stay. No severe side effects were reported. All patients met the criteria for a potential pediatric bipolar phenotype.
  
  
  CONCLUSIONS
  This was a retrospective study without randomization or a control group. Additionally, the non-blinded design may have biased the raters concerning the effectiveness of divalproex for impulsive aggression.
  
  
  CONCLUSIONS
  Our data are in line with divalproex response in children and adolescents with target symptoms of explosive temper and mood instability. Our data further suggest that such symptoms, coupled with impulsive aggression and irritability, as well as related manic symptoms, constitute a pediatric divalproex-responsive bipolar spectrum disorder.
authors.affiliation: Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA. drew.barzman@fuse.net
authors.forename: Drew H
authors.initials: DH
authors.lastname: Barzman
authors.forename: Brian J
authors.initials: BJ
authors.lastname: McConville
authors.forename: Brian
authors.initials: B
authors.lastname: Masterson
authors.forename: Susan
authors.initials: S
authors.lastname: McElroy
authors.forename: Gopalan
authors.initials: G
authors.lastname: Sethuraman
authors.forename: Krissell
authors.initials: K
authors.lastname: Moore
authors.forename: Ann-Marie
authors.initials: AM
authors.lastname: Kahwaty
authors.forename: Daniel
authors.initials: D
authors.lastname: Nelson
mesh_terms: D000293:Adolescent; D000374:Aggression / Q000523:psychology*; D018692:Antimanic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000150:complications / Q000188:drug therapy* / Q000523:psychology; D002648:Child; D005260:Female; D006801:Humans; D007175:Impulsive Behavior; D007297:Inpatients; D007508:Irritable Mood; D008297:Male; D010641:Phenotype; D012189:Retrospective Studies; D016896:Treatment Outcome; D014635:Valproic Acid / Q000627:therapeutic use*
chemical_list: D018692:Antimanic Agents; D014635:Valproic Acid