title: Pharmacotherapy of Aggression in Child and Adolescent Psychiatric Disorders.
abstract: OBJECTIVE
  Aggression is a common, yet complex, behavioral complaint, and a frequent indication for referral to child and adolescent psychiatrist treatment. This article reviews the evidence supporting pharmacotherapy of aggression in youth, with a primary focus on impulsive aggression (the primary indication for this intervention). Relevant diagnostic considerations and consensus guidelines are discussed.
  
  
  METHODS
  Articles examining the role of medications in the treatment of aggression in youth with pathological aggression were identified using PubMed and MEDLINE® databases over the past 15 years (2000-2015); selected articles published prior to 2000 and deemed to be of high relevance were searched and also included. Search terms included: Aggression, aggressive, disruptive behavior, conduct, youth, children, and adolescents. Cited references were also searched for relevant articles.
  
  
  RESULTS
  There are a number of evidence-based medication treatments for aggression, which are generally best considered in the context of differential diagnosis and ongoing evidence-based psychosocial interventions. Impulsive aggression is generally considered the type of aggression most amenable to medication, but other aggression subtypes may also possibly respond to treatment. Medication classes with positive evidence include the psychostimulants and α-2 agonists (in the presence of attention-deficit/hyperactivity disorder [ADHD] and/or disruptive behavior disorders), mood stabilizing agents, and atypical antipsychotics. Published guidelines recommend systematic and adequate trials of medications in sequential order, to optimize response and minimize polypharmacy. Guidelines for safety monitoring are available for many of the medications used for aggression in youth, and are also discussed.
  
  
  CONCLUSIONS
  Aggression in children carries a high risk of poor outcomes, and, therefore, a better understanding of treatment options is a high priority. The available literature points to the importance of identifying the underlying disorder, when possible, and using this information to guide treatment selection. Future studies are needed to better inform the treatment of aggression across disorders, and the treatment of different aggression subtypes.
authors.affiliation: 1 Department of Psychiatry, Mount Sinai-St. Luke's Hospital Center , New York, New York.
authors.forename: Tina
authors.initials: T
authors.lastname: Gurnani
authors.affiliation: 1 Department of Psychiatry, Mount Sinai-St. Luke's Hospital Center , New York, New York.|2 Department of Psychiatry, Icahn School of Medicine at Mount Sinai , New York, New York.
authors.forename: Iliyan
authors.initials: I
authors.lastname: Ivanov
authors.affiliation: 2 Department of Psychiatry, Icahn School of Medicine at Mount Sinai , New York, New York.
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Newcorn
mesh_terms: D000293:Adolescent; D000374:Aggression / Q000523:psychology*; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000188:drug therapy; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D002648:Child; D002653:Child Behavior Disorders / Q000188:drug therapy*; D006801:Humans; D007175:Impulsive Behavior; D011619:Psychotropic Drugs / Q000627:therapeutic use*
chemical_list: D014150:Antipsychotic Agents; D000697:Central Nervous System Stimulants; D011619:Psychotropic Drugs