Annotated Bibliography
Date: 2/5/2013 Name: Andrew Iraheta, Josh Tran APA Style Reference. Masi, G., Milone, A., Manfredi, A., Pari, C., Paziente, A., & Millepiedi, S. (2009). Effectiveness of lithium in children and adolescents with conduct disorder. CNS Drugs 23 (1), 59-69. doi: 10.2165/0023210-200923010-00004. | Rationale for the study. There have been varying results that question the effectiveness of Lithium as a treatment for Conduct Disorder. Some studies claimed positive results in treating severe cases Conduct Disorder, but these studies are scarce so further study is needed. The Rationale for this study was to find out the effectiveness of treating Conduct Disorder in children/adolescents with Lithium and identify the positive
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and/or negative effects that come from this treatment. | Hypotheses / Research Questions.
The research was to identify if Lithium was an effective monotherapy treatment for conduct disorder. Lithium or in combination with atypical antipsychotics was explored to identify the negative and positive responses to the treatments. Children and adolescents were examined to determine the effects and tolerability of these treatments. | The Independent Variables for this study were the Lithium monotherapy, Psychostimulants, atypical antipsychotics, and SSRI’sThe Dependent Variables were the children/adolescents’ levels of aggression, as well as behavior in general, and their global assessment of functioning. In terms of predictors the study emphasizes that these are highly debated and can vary greatly. However the study claims that predatory and profitable aggression make patients more likely to be resistant to medication. | Findings Lithium monotherapy treatment improved significantly with exception of self-aggression (p.89). Patients who took lithium along with atypical antipsychotic therapy improved significantly (p/= .80. Between the two treatments, baseline clinical severity and functional impairment assesments indicate no statistical difference. 1/3 of participants had adverse effect that includes vomiting, nausea, stomach complaints, urinary frequency, tremors, thyroid dysfunction and possible weight gain.
| Major Discussion Points. A major discussion point was that the Lithium treatment often had to be co-administered with another drug, which helped patients become “responders”. This pairing of drugs was suggested to be good therapeutic strategy when Lithium was not effective alone. Since half of the participants were non-responders there was other consideration taken into why these participants were non-responders. This led to another discussion point that went into the predictors that arose. One such predictor was low self-aggression, which was indicative of high effectiveness. Another predictor was predatory aggressiveness, which was indicative of high resistance to the treatment. In general those who display more aggression were the ones who were more likely to be resistant to the therapy. Another point was the fact that Conduct Disorder was comorbid with many other disorders in this study. This could have made the patients more resistant to Lithium therapy as well as Lithium paired with another drug. | Study Design. 60 patients diagnosed with conduct disorder were treated with Lithium individually or in combination with atypical antipsychotic if necessary. All patients and family signed written consent forms voluntarily for assessments and treatment procedures. There were 46 males and 14 females between the ages of 8-17. Behavioral symptoms were assessed at baseline and during follow-up periods. The follow-up period was between 6-12 months. | Limitations One of the major limitations of this study was that it was not randomized or controlled. The data collected was from one clinic and the sample size was relatively small. Their findings may not be able to be generalized. There was also a referral bias that may have resulted in the study getting more resistant patients. The fact that there was a high comorbidity rate may have also contributed to the limitations of this study. The study did not take into account gender differences in response to self-reporting and treatment. | Discussion Question(s). The authors stated it was unclear to whether Lithium had possible treatment effects or the effects occurred from a time effect. The uncertainty stems from the sample being naturalistically determined. Therefore, it was heterogeneous as to co-morbidity and treatments. Some of the patients may have responded well to antipsychotic monotherapy but this was not an option. The study had a small sample and clinical records were obtained from only one intervention site. Furthermore, patient selection may have caused bias results. | Clarification. The study displays Conduct Disorder as a gender-neutral disorder, but in reality there are different manifestations of the disorder in each gender. Both boys and girls display aggression in different manners and Conduct Disorder is typically more present in boys because their aggression is much easier to identify. In girls aggression is more covert and is typically displayed through social aggression and not physical aggression which boys typically demonstrate. The study seemed to assess girls on a standard that boys are typically assessed with and this may have been a confound that was not addressed. We feel that there should be more in depth research regarding Conduct Disorder and how it is treated and displayed females. |
and/or negative effects that come from this treatment. | Hypotheses / Research Questions.
The research was to identify if Lithium was an effective monotherapy treatment for conduct disorder. Lithium or in combination with atypical antipsychotics was explored to identify the negative and positive responses to the treatments. Children and adolescents were examined to determine the effects and tolerability of these treatments. | The Independent Variables for this study were the Lithium monotherapy, Psychostimulants, atypical antipsychotics, and SSRI’sThe Dependent Variables were the children/adolescents’ levels of aggression, as well as behavior in general, and their global assessment of functioning. In terms of predictors the study emphasizes that these are highly debated and can vary greatly. However the study claims that predatory and profitable aggression make patients more likely to be resistant to medication. | Findings Lithium monotherapy treatment improved significantly with exception of self-aggression (p.89). Patients who took lithium along with atypical antipsychotic therapy improved significantly (p/= .80. Between the two treatments, baseline clinical severity and functional impairment assesments indicate no statistical difference. 1/3 of participants had adverse effect that includes vomiting, nausea, stomach complaints, urinary frequency, tremors, thyroid dysfunction and possible weight gain.
| Major Discussion Points. A major discussion point was that the Lithium treatment often had to be co-administered with another drug, which helped patients become “responders”. This pairing of drugs was suggested to be good therapeutic strategy when Lithium was not effective alone. Since half of the participants were non-responders there was other consideration taken into why these participants were non-responders. This led to another discussion point that went into the predictors that arose. One such predictor was low self-aggression, which was indicative of high effectiveness. Another predictor was predatory aggressiveness, which was indicative of high resistance to the treatment. In general those who display more aggression were the ones who were more likely to be resistant to the therapy. Another point was the fact that Conduct Disorder was comorbid with many other disorders in this study. This could have made the patients more resistant to Lithium therapy as well as Lithium paired with another drug. | Study Design. 60 patients diagnosed with conduct disorder were treated with Lithium individually or in combination with atypical antipsychotic if necessary. All patients and family signed written consent forms voluntarily for assessments and treatment procedures. There were 46 males and 14 females between the ages of 8-17. Behavioral symptoms were assessed at baseline and during follow-up periods. The follow-up period was between 6-12 months. | Limitations One of the major limitations of this study was that it was not randomized or controlled. The data collected was from one clinic and the sample size was relatively small. Their findings may not be able to be generalized. There was also a referral bias that may have resulted in the study getting more resistant patients. The fact that there was a high comorbidity rate may have also contributed to the limitations of this study. The study did not take into account gender differences in response to self-reporting and treatment. | Discussion Question(s). The authors stated it was unclear to whether Lithium had possible treatment effects or the effects occurred from a time effect. The uncertainty stems from the sample being naturalistically determined. Therefore, it was heterogeneous as to co-morbidity and treatments. Some of the patients may have responded well to antipsychotic monotherapy but this was not an option. The study had a small sample and clinical records were obtained from only one intervention site. Furthermore, patient selection may have caused bias results. | Clarification. The study displays Conduct Disorder as a gender-neutral disorder, but in reality there are different manifestations of the disorder in each gender. Both boys and girls display aggression in different manners and Conduct Disorder is typically more present in boys because their aggression is much easier to identify. In girls aggression is more covert and is typically displayed through social aggression and not physical aggression which boys typically demonstrate. The study seemed to assess girls on a standard that boys are typically assessed with and this may have been a confound that was not addressed. We feel that there should be more in depth research regarding Conduct Disorder and how it is treated and displayed females. |