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Anticonvulsants for Psychiatric Disorders in Children and Adolescents: A Systematic Review of Their Efficacy

Aim: Anticonvulsant medications are frequently used in clinical practice to treat psychiatric disorders in children and adolescents, but the evidence for their efficacy is uncertain. We conducted a systematic review of published randomized controlled trials (RCT) that assessed the psychiatric benefi...

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Autores principales: Davico, Chiara, Canavese, Carlotta, Vittorini, Roberta, Gandione, Marina, Vitiello, Benedetto
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6024111/
https://www.ncbi.nlm.nih.gov/pubmed/29988399
http://dx.doi.org/10.3389/fpsyt.2018.00270
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author Davico, Chiara
Canavese, Carlotta
Vittorini, Roberta
Gandione, Marina
Vitiello, Benedetto
author_facet Davico, Chiara
Canavese, Carlotta
Vittorini, Roberta
Gandione, Marina
Vitiello, Benedetto
author_sort Davico, Chiara
collection PubMed
description Aim: Anticonvulsant medications are frequently used in clinical practice to treat psychiatric disorders in children and adolescents, but the evidence for their efficacy is uncertain. We conducted a systematic review of published randomized controlled trials (RCT) that assessed the psychiatric benefit of anticonvulsants in patients under 18 years of age. Method: The Medline, Scopus, Web of Science, and ClinicalTrials.gov databases were systematically searched for peer-reviewed primary publications of RCTs with a minimum of 10 patients per treatment arm through December 2017. Results: Out of 355 identified non-duplicative publications, 24 met the inclusion criteria. Most RCTs were to treat bipolar disorder (n = 12) or manage recurrent aggression (n = 9). Few (n = 3) had both a multisite design and adequate statistical power. Valproate was the most frequently studied anticonvulsant (n = 15). Out of three placebo-controlled RCTs of valproate in bipolar disorder, none showed efficacy. In four RCTs, valproate was inferior to the antipsychotic risperidone. In several small, single-site RCTs, valproate and sulthiame were better than placebo for the management of recurrent aggression. Conclusions: Currently available RCTs do not support the efficacy of anticonvulsants as mood stabilizers in children. There is some preliminary evidence from small RCTs of the efficacy of some anticonvulsants in the control of aggression and behavioral dyscontrol in conduct disorder, autism, and intellectual disability.
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spelling pubmed-60241112018-07-09 Anticonvulsants for Psychiatric Disorders in Children and Adolescents: A Systematic Review of Their Efficacy Davico, Chiara Canavese, Carlotta Vittorini, Roberta Gandione, Marina Vitiello, Benedetto Front Psychiatry Psychiatry Aim: Anticonvulsant medications are frequently used in clinical practice to treat psychiatric disorders in children and adolescents, but the evidence for their efficacy is uncertain. We conducted a systematic review of published randomized controlled trials (RCT) that assessed the psychiatric benefit of anticonvulsants in patients under 18 years of age. Method: The Medline, Scopus, Web of Science, and ClinicalTrials.gov databases were systematically searched for peer-reviewed primary publications of RCTs with a minimum of 10 patients per treatment arm through December 2017. Results: Out of 355 identified non-duplicative publications, 24 met the inclusion criteria. Most RCTs were to treat bipolar disorder (n = 12) or manage recurrent aggression (n = 9). Few (n = 3) had both a multisite design and adequate statistical power. Valproate was the most frequently studied anticonvulsant (n = 15). Out of three placebo-controlled RCTs of valproate in bipolar disorder, none showed efficacy. In four RCTs, valproate was inferior to the antipsychotic risperidone. In several small, single-site RCTs, valproate and sulthiame were better than placebo for the management of recurrent aggression. Conclusions: Currently available RCTs do not support the efficacy of anticonvulsants as mood stabilizers in children. There is some preliminary evidence from small RCTs of the efficacy of some anticonvulsants in the control of aggression and behavioral dyscontrol in conduct disorder, autism, and intellectual disability. Frontiers Media S.A. 2018-06-22 /pmc/articles/PMC6024111/ /pubmed/29988399 http://dx.doi.org/10.3389/fpsyt.2018.00270 Text en Copyright © 2018 Davico, Canavese, Vittorini, Gandione and Vitiello. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Psychiatry
Davico, Chiara
Canavese, Carlotta
Vittorini, Roberta
Gandione, Marina
Vitiello, Benedetto
Anticonvulsants for Psychiatric Disorders in Children and Adolescents: A Systematic Review of Their Efficacy
title Anticonvulsants for Psychiatric Disorders in Children and Adolescents: A Systematic Review of Their Efficacy
title_full Anticonvulsants for Psychiatric Disorders in Children and Adolescents: A Systematic Review of Their Efficacy
title_fullStr Anticonvulsants for Psychiatric Disorders in Children and Adolescents: A Systematic Review of Their Efficacy
title_full_unstemmed Anticonvulsants for Psychiatric Disorders in Children and Adolescents: A Systematic Review of Their Efficacy
title_short Anticonvulsants for Psychiatric Disorders in Children and Adolescents: A Systematic Review of Their Efficacy
title_sort anticonvulsants for psychiatric disorders in children and adolescents: a systematic review of their efficacy
topic Psychiatry
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6024111/
https://www.ncbi.nlm.nih.gov/pubmed/29988399
http://dx.doi.org/10.3389/fpsyt.2018.00270
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