Recommendations for pharmacological management of inpatient aggression in children and adolescents.

Parikshit Deshmukh, Guarav Kulkarni, Drew Barzman
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Abstract

Objective. While there has been a great deal of speculation by clinical researchers over the last three decades on effective and safe methods for the pharmacological management of aggression in children and adolescents, it is only in the last decade that there have been well-designed studies available to address this issue. Medication is commonly used to control aggression in children and adolescents in inpatient units. Also, there exists a need for evidence-based guidelines for the use of these different pharmacological agents for managing pediatric aggression on inpatient units. The aims of this article are to provide a systemic review and to provide treatment guidelines based on these limited but currently available studies.Methods. The articles reviewed in this study were obtained through a PubMed search using the key words 'children,' 'adolescents,' 'aggression,' 'inpatient,' 'ziprasidone,' 'lithium,' and 'risperidone.' A total of 499 studies were generated. Only studies focusing on pharmacological management of inpatient pediatric aggression with mean duration less than six weeks and published during January 1980 to August 2009 were included. Only English articles were considered. A total of 13 studies met these criteria, which were included in the review without any further statistical analysis. Recommendations are made on this available evidenced-based literature.Results. There is some evidence for the standing use of oral lithium, haloperidol, olanzapine, and risperidone for aggression related to specific psychiatric diagnoses. Intramuscular ziprasidone and olanzapine administered as needed were found to be effective for the rapid management of moderate to severe aggression. Oral or intramuscular diphenhydramine administered as needed was found to be useful for managing mild aggression due to a placebo effect.Conclusions. Studies are available on managing aggression in children and adolescents in inpatient treatment settings but are limited. Further studies on the use of various psychotropic medications are needed in order to develop comprehensive guidelines for the safe and effective pharmacological management of child and adolescent inpatient aggression.

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儿童和青少年住院攻击的药理学管理建议。
目标。虽然在过去的三十年里,临床研究人员对儿童和青少年攻击性的有效和安全的药物管理方法进行了大量的推测,但只有在过去的十年里,才有精心设计的研究可以解决这个问题。药物通常用于控制住院儿童和青少年的攻击性。此外,还需要制定基于证据的指南,以使用这些不同的药理学药物来管理住院病房的儿科攻击。本文的目的是对这些有限但目前可用的研究进行系统回顾,并提供治疗指南。本研究中回顾的文章是通过PubMed搜索获得的,关键词是“儿童”、“青少年”、“攻击性”、“住院”、“齐拉西酮”、“锂”和“利培酮”。总共产生了499项研究。仅纳入1980年1月至2009年8月期间发表的平均持续时间小于6周的住院儿童攻击的药理管理研究。只考虑英文文章。共有13项研究符合这些标准,这些研究在没有进一步统计分析的情况下被纳入本综述。根据现有的循证文献提出建议。有一些证据表明,长期使用口服锂、氟哌啶醇、奥氮平和利培酮治疗与特定精神疾病诊断相关的攻击。根据需要肌注齐拉西酮和奥氮平对中重度攻击的快速治疗有效。根据需要口服或肌肉注射苯海拉明对控制由于安慰剂效应引起的轻度攻击是有用的。关于在住院治疗环境中管理儿童和青少年的攻击行为的研究是可用的,但有限。需要对各种精神药物的使用进行进一步的研究,以便为儿童和青少年住院患者攻击的安全有效的药理管理制定全面的指导方针。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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