title: Comorbid oppositional defiant disorder and the risk of relapse during 9 months of atomoxetine treatment for attention-deficit/hyperactivity disorder.
abstract: OBJECTIVE
  To examine the influence of comorbid oppositional defiant disorder (ODD) on the relative risk (RR) of relapse during 9 months of treatment with atomoxetine for attention-deficit/hyperactivity disorder (ADHD).
  
  
  METHODS
  Four hundred and sixteen children and adolescents with ADHD whose symptoms remitted during initial 10-week, open-label atomoxetine treatment were randomly assigned to continue with atomoxetine or placebo.
  
  
  RESULTS
  In all, 43% met criteria for comorbid ODD. A total of 17% of patients with comorbid ODD relapsed (CGI-Severity score >or= 3 and ADHD Rating Scale total score of 90% or more of baseline at study entry on two consecutive visits) during atomoxetine treatment, compared with 26% of patients without comorbid ODD (RR 0.67, 95% CI 0.42-1.06). Mean time to relapse was not significantly different [mean (SE) days to relapse, ADHD/ +ODD: 215 (7.38); ADHD/-ODD: 211 (7.61); log rank p = 0.08]. This finding is placed within the context of atomoxetine affording an overall protection against relapse compared with placebo (RR 0.59, 95% CI 0.43-0.80).
  
  
  CONCLUSIONS
  Comorbid ODD does not influence the rate of relapse of patients with ADHD during longer-term treatment with atomoxetine. Atomoxetine protects against the relapse of ADHD symptoms regardless of the presence or absence of comorbid ODD.
authors.affiliation: Child and Youth Mental Health Service, University of Newcastle, Locked Bag 1014, Wallsend, NSW 2287, Australia. philip.hazell@hne.health.nsw.gov.au
authors.forename: Philip
authors.initials: P
authors.lastname: Hazell
authors.forename: Shuyu
authors.initials: S
authors.lastname: Zhang
authors.forename: Tomasz
authors.initials: T
authors.lastname: Wolańczyk
authors.forename: Joanne
authors.initials: J
authors.lastname: Barton
authors.forename: Mats
authors.initials: M
authors.lastname: Johnson
authors.forename: Alessandro
authors.initials: A
authors.lastname: Zuddas
authors.forename: Marina
authors.initials: M
authors.lastname: Danckaerts
authors.forename: Andrula
authors.initials: A
authors.lastname: Ladikos
authors.forename: David
authors.initials: D
authors.lastname: Benn
authors.forename: Roni
authors.initials: R
authors.lastname: Yoran-Hegesh
authors.forename: Pal
authors.initials: P
authors.lastname: Zeiner
authors.forename: David
authors.initials: D
authors.lastname: Michelson
mesh_terms: D000293:Adolescent; D018759:Adrenergic Uptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D000069445:Atomoxetine Hydrochloride; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000175:diagnosis / Q000453:epidemiology*; D002648:Child; D015897:Comorbidity; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D011437:Propylamines / Q000009:adverse effects / Q000627:therapeutic use*; D012008:Recurrence; D012306:Risk; D012720:Severity of Illness Index
chemical_list: D018759:Adrenergic Uptake Inhibitors; D011437:Propylamines; D000069445:Atomoxetine Hydrochloride