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Divalproex Sodium for the Treatment of PTSD and Conduct Disordered Youth: A Pilot Randomized Controlled Clinical Trial

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Abstract

We examined the efficacy of divalproex sodium (DVP) for the treatment of PTSD in conduct disorder, utilizing a previous study in which 71 youth were enrolled in a randomized controlled clinical trial. Twelve had PTSD. Subjects (all males, mean age 16,␣SD 1.0) were randomized into high and low dose conditions. Clinical Global Impression (CGI) ratings for core PTSD symptoms (Intrusion, avoidance and hyper arousal) were primary outcome measures, weekly slopes of impulsivity secondary ones. Intent-to-treat analyses showed significant positive associations between receiving high dose of DVP CGI’s. Parallel analyses comparing outcome by drug level achieved strengthened the results.

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References

  1. Kessler RC, Sonnega A, Bromet, E (1999) Risk factors for posttraumatic stress disorder. In: Yehuda R (ed) American Psychiatric Association, Washington, DC, US, pp 23–59

  2. Giaconia RM, Reinherz HZ, Silverman AB (1995) Traumas and posttraumatic stress disorder in a community population of older adolescents. J Am Acad Child Adolesc Psychiatry 34(10):1369–1380

    Article  PubMed  Google Scholar 

  3. Berman SL, Kurtines WM, Silverman WK (1996) The impact of exposure to crime and violence on urban youth. Am J Orthopsychiatry 3(66):329–336

    Article  Google Scholar 

  4. Cauffman E, Feldman SS, Waterman J, Steiner H (1998) Posttraumatic stress disorder among incarcerated females. J Am Acad Child Adolesc Psychiatry 37(11):1209–1216

    Article  PubMed  Google Scholar 

  5. Steiner H, Garcia IG, Matthews Z (1997) Posttraumatic stress disorder in incarcerated juvenile delinquents. J Am Acad Child Adolesc Psychiatry 36(3):357–365

    Article  PubMed  Google Scholar 

  6. McLeer SV, Deblinger EB, Henry D (1992) Sexually abused children at high risk for post-traumatic stress disorder. J Am Acad Child Adolesc Psychiatry 31(5):875–879

    Article  PubMed  Google Scholar 

  7. Famularo R, Fenton Terence, Augustyn M (1996) Persistence of pediatric posttraumatic stress disorder after 2 years. Child Abuse & Neglect 20(12):1245–1248

    Article  Google Scholar 

  8. Pfefferbaum B (1997) Posttraumatic stress disorder in children: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry 36(11):1503–1511

    Article  PubMed  Google Scholar 

  9. Donnelly CL, Amaya JL, March JS (1999) Psychopharmacology of pediatric posttraumatic stress disorder. J Child Adolesc Psychopharmacol Ann 9(3):203–220

    Article  Google Scholar 

  10. RUPP STUDY GROUP (2001) Fluvoxamine for the treatment of anxiety disorders in children and adolescents. New England Journal of Medicine 1279–1285

  11. Famularo R, Kinscherff R, Fenton T (1988) Propranolol treatment for childhood posttraumatic stress disorder, acute type. A pilot study. Am J Dis Child 142(11):1244–1247

    PubMed  Google Scholar 

  12. Harmon RJ, Riggs PD (1996) Clonidine for posttraumatic stress disorder in preschool children. J Am Acad Child Adolesc Psychiatry 35(9):1247–1249

    Article  PubMed  Google Scholar 

  13. Nader KO, Pynoos RS, Fairbanks LA, Al-Ajeel M, Al-Asfour A (1993) A preliminary study of PTSD and grief among the children of Kuwait following the Gulf crisis. Br J Clin Psychol 32(Pt 4):407–416

    PubMed  Google Scholar 

  14. Post RM, Weiss SRB, Smith M, Li H, McCann U (1997) Kindling vs. quenching: implications for the evolution and treatment of PTSD. Ann NY Acad Sci 821:285–295

    Article  PubMed  Google Scholar 

  15. Wilcox J (1994) Divalproex sodium in the treatment of aggressive behavior. Ann Clin Psychiatry 6(1):17–20

    Article  PubMed  Google Scholar 

  16. Donovan SJ, Susser ES, Nunes EV, Stewart JW, Quitkin FM, Klein DF (1997) Divalproex treatment of disruptive adolescents: a report of 10 cases. J Clin Psychiatry 58:12–15

    PubMed  Google Scholar 

  17. Loof D, Grimley P, Kuller F (1995) Carbamazepine found efficacious for some children, adolescents with PTSD. Special Report: Anxiety Disorders. Psychiatric Times 23

  18. Fesler FA (1991) Valproate in combat related posttraumatic stress disorder. J Clin Psychiatry 52:361–364

    PubMed  Google Scholar 

  19. Rana M, Khanzode LA, Karnik N, Saxena K, Chang K, Steiner H (2005) Divalproex sodium in the treatment of pediatric psychiatric disorders. Expert Rev Neurother 5(2):165–176

    Article  PubMed  Google Scholar 

  20. Steiner H, Petersen M, Saxena K, Ford S, Matthews Z (2003) Divalproex Sodium for the treatment of Severe Conduct Disorder: a randomized controlled clinical trial. J of Clinical Psychiatry 64:1183–1191

    Google Scholar 

  21. Othmer E, Penick EC, Powell BJ, Read MR, Othmer SC (1981) Psychiatric Diagnostic Interview- Revised (PDI-R). Los Angeles, Western Psychological Services

    Google Scholar 

  22. Achenbach TM (1991) Manual for Youth Self-Report and 1991 Profile. Burlington, VT, University of Vermont Dept. of Psychiatry

    Google Scholar 

  23. Weinberger D (1997) Distress and self-restraint as measures of adjustment across the life Span: confirmatory factor analysis in clinical and nonclinical samples. Psychol Assess 9(2):132–135

    Article  Google Scholar 

  24. Guy W (1976) ECDEU Assessment Manual for Psychopharmacology, 2nd ed. Washington DC, US Government Printing Office

    Google Scholar 

  25. Deltito JA, Levitan J, Damore J, Hajal F, Zambenedetti M (1998) Naturalistic experience with the use of divalproex sodium on an in-patient unit for adolescent psychiatric patients. Acta Pschiatr Scand 97:236–240

    Article  Google Scholar 

  26. Feldman SS, Weinberger DA (1995) Self-restraint as a mediator of family influences on boys’ delinquent behavior: a longitudinal study. Child Dev 65: 195–121, 1994. Weinberger DA, Gomes ME: Changes in daily mood and self-restraint among under controlled preadolescents: a time series analysis of “acting out”, J Am Acad Child Adolesc Psychiatry 34(11):1473–1482

    Google Scholar 

  27. Lasko NB, Gurvits TV, Kuhne AA, Orr SP, Pitman RK (1994) Aggression and its correlates in Vietnam veterans with and without chronic posttraumatic stress disorder. Compr Psychiatry 35(5):373–381

    Article  PubMed  Google Scholar 

  28. Begic D, Jokie BN (2001) Aggressive behavior in combat veterans with post-traumatic stress disorder. Mil Med 166(8):671–676

    PubMed  Google Scholar 

  29. Donovan SJ, Stewart JW, Nunes EV, Quitkin FM, Parides M, Daniel W (2000) Divalproex treatment for youth with explosive temper and mood lability: a double-blind, placebo-controlled crossover design. Am J Psychiatry 157(5):818–820

    Article  PubMed  Google Scholar 

  30. Donovan SJ, Nunes EV, Stewart JW, Ross D, Quitkin FM, Jensen PS et al (2003) “Outer-Directed Irritability”: a distinct mood syndrome in explosive youth with a disruptive behavior disorder? J Clin Psychiatry 64(6):698–701

    Article  PubMed  Google Scholar 

  31. Steiner H, Saxena K, Chang K (2003) Psychopharmacological Strategies for the treatment of Aggression in Juveniles. CNS Spectrum 8(4):298–308

    Google Scholar 

  32. Wagner K (2002) An Open–label trial of divalproex in children & adolescents with Bipolar disorder. J␣Am Acad Child Adolesc Psychiatry 41(10):1224–1230

    Article  PubMed  Google Scholar 

  33. Ohtsuka Y, Amano R, Mizukawa M, Oka E, Ohtahara S (1992) Treatment of intractable childhood epilepsy with high-dose valproate. Epilepsia 33(1):158–164

    Article  PubMed  Google Scholar 

  34. Steiner H, and AAACAP Work Group on Quality Issues (1997) Practice parameters for the assessment and treatment of children and adolescents with conduct disorder. J Am Acad Child Adolesc Psychiatry 36(10):122S–19S

    Google Scholar 

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Acknowledgements

This research was supported by grants to Dr. Steiner by Abbott Pharmaceuticals, The California Wellness Foundation and by the California Youth Authority.

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Correspondence to Leena A. Khanzode.

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Steiner, H., Saxena, K.S., Carrion, V. et al. Divalproex Sodium for the Treatment of PTSD and Conduct Disordered Youth: A Pilot Randomized Controlled Clinical Trial. Child Psychiatry Hum Dev 38, 183–193 (2007). https://doi.org/10.1007/s10578-007-0055-8

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  • DOI: https://doi.org/10.1007/s10578-007-0055-8

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