Clozapine in the Treatment of Aggression in Conduct Disorder in Children and Adolescents: A Randomized, Double-blind, Controlled Trial

2. Article – Clozapine for Conduct Disorder

Juárez-Treviño, M., Esquivel, A. C., Isida, L., Delgado, D., de la O Cavazos, M. E., Ocañas, L. G., & Sepúlveda, R. S. (2019). Clozapine in the Treatment of Aggression in Conduct Disorder in Children and Adolescents: A Randomized, Double-blind, Controlled Trial. Clinical psychopharmacology and neuroscience : the official scientific journal of the Korean College of Neuropsychopharmacology, 17(1), 43–53. https://doi.org/10.9758/cpn.2019.17.1.43

A number of different interventions have been used to treat youth with conduct disorder. Cognitive therapy, behavioral therapy, and combination cognitive-behavioral therapy are most frequently utilized. Although there is no medication formally approved to treat conduct disorder, various drugs may be used (off label) to treat some of its distressing symptoms, such as impulsivity, aggression, dysregulated mood, as well as any other mental illnesses that may be present, such as ADHD or major depression.

Clozapine use in treating aggression in conduct disorder has not been suitably studied. The aim of this study was to compare the efficacy of clozapine versus risperidone, the gold standard for treatment of aggression in children and adolescents with conduct disorder.

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. Three different types of scales were used to measure the outcome, the Modified Overt Aggression Scale score was used as the primary outcome of the study.

Sixty-five aggressive children and adolescents with conduct disorder were screened. Twenty-four were randomized to receive either clozapine or risperidone. After analysis, they found 1) Both antipsychotics were similarly effective in the primary outcome and in most of the secondary ones. 2) Clozapine was more effective in CBCL-E, the delinquency subscale and the CGAS scores than risperidone.

In 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. This article can help me to build up my management plan for patient TC, who has been diagnosed as conduct disorder. In my plan, I do not provide any medication at that time since patient does not present server aggressive behavior. However, if aggression occurs, short term use of clozapine will be a good choice according to this article.