Divalproex sodium for the treatment of conduct disorder: a randomized controlled clinical trial.

Abstract

BACKGROUND:

New treatments for conduct disorder are sorely needed. We aimed to test the efficacy of divalproex sodium for the treatment of conduct disorder.

METHOD:

Seventy-one youths with conduct disorder according to DSM-IV criteria were enrolled in a randomized, controlled, 7-week clinical trial. Subjects were all adolescent males with at least 1 crime conviction. Subjects were randomized into high- and low-dose conditions and were openly managed by a clinical team. Subjects and independent outcome raters were blinded to condition. Clinical Global Impressions-Severity of Illness (CGI-S) and CGI-Improvement (CGI-I) ratings, Weinberger Adjustment Inventory ratings, and staff ratings of behavioral privilege were used to assess outcome.

RESULTS:

Intent-to-treat analyses showed significant associations between assignment to the high-dose condition and ratings on the CGI-S (p =.02) and CGI-I (p =.0008). Self-reported weekly impulse control was significantly better in the high-dose condition (p <.05), and association between improvement in self-restraint and treatment condition was of borderline statistical significance (p <.06). Parallel analyses comparing outcome by blood drug level achieved strengthened the results, as expected.

CONCLUSION:

This preliminary study in a most difficult population suggests a role for divalproex sodium in the treatment of conduct disorder. Divalproex sodium improved self-reported impulse control and self-restraint, variables shown to be predictive of criminal recidivism. Studies are needed of longer-term impact and side-effect profiles. This is one of few controlled psychopharmacologic studies of conduct disorder.

• Authors: Hans Steiner, Maya L Petersen, Kirti Saxena, Sekou Ford, Zakee Matthews
• Journal: The Journal of clinical psychiatry (J Clin Psychiatry) Vol. 64 Issue 10 Pg. 1183-91 (Oct 2003) ISSN: 0160-6689 [Print] United States
• PMID: 14658966 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Anticonvulsants
• Valproic Acid

Topics

• Adolescent
• Aggression (drug effects)
• Anger (drug effects)
• Anticonvulsants (administration & dosage, adverse effects)
• Arousal (drug effects)
• Conduct Disorder (diagnosis, drug therapy)
• Crime (prevention & control)
• Dose-Response Relationship, Drug
• Double-Blind Method
• Humans
• Internal-External Control
• Juvenile Delinquency (rehabilitation)
• Male
• Personality Assessment
• Personality Inventory
• Residential Treatment
• Socialization
• Treatment Outcome
• Valproic Acid (administration & dosage, adverse effects)