Intranasal Oxytocin for Internalizing Symptoms in Youth With Disruptive Behavior Disorders
Highlights from Posters Presented at the Society of Biological Psychiatry Meeting, April 27-29, 2023 in San Diego
E. Kendall reported that “Fifty-two youths with diagnoses of DBD [Disruptive Behavior Disorders] participated in [this] study, and twenty-five completed three weeks of treatment of intranasal OXT [oxytocin] and twenty-seven placebo (PBO)…. Youth who received OXT showed a significantly greater reduction of depression [ p=0.012] and anxiety [p=0.031] compared to the [placebo] group.”
They concluded that “Intranasal OXT can show efficacy in reducing internalizing symptoms in youth with DBD. This was accompanied by neural level changes implicated in emotion regulation (mPFC [medial prefrontal cortex] and ACC [anterior cingulate cortex]).”
A New Treatment for Disruptive Mood Dysregulation
The 2013 update to the Diagnostic and Statistical Manual of Mental Disorders, or the DSM-5, included a new diagnosis of disruptive mood dysregulation disorder. Children with persistent, severe temper outbursts and irritable or angry moods that are out of proportion to circumstances may be diagnosed with the disorder. However, there is not much specificity to the diagnosis and few treatment studies have been done to help clinicians and parents determine how to manage symptoms of the disorder.
A poster presented at the 2017 Psych Congress reported that a medication protocol consisting of an anticonvulsant drug to stabilize moods and temper outbursts and a dopamine agonist to reduce irritability, impulsivity, and concentration problems reduced rates of re-hospitalization. The retrospective study by researchers D. Matthews and G. Matthews included 91 children and adolescents who were prescribed the anticonvulsant oxcarbazepine and the dopamine agonist amantadine following hospitalization for severe aggression, mood instability, and impulsivity. Those who stuck to the regimen with minimal changes for one year had an 8% re-hospitalization rate compared to a 26% re-hospitalization rate among those who discontinued the regimen or substituted other drugs.
Editor’s Note: Oxcarbazepine has a long-acting preparation, Oxtellar, that can be given all at night.
Amantadine (Symmetrel) not only is a dopamine agonist used for Parkinson’s disease, but is also an antiviral and a blocker of glutamate NMDA channels. It stabilizes the closed state of the NMDA channel.
Faster, Better Response to Risperidone than Valproate in Adolescents with Bipolar Disorder
An article by Pavuluri et al. published in Bipolar Disorders in September reported that both divalproex sodium (valproate, or Depakote) and risperidone (Risperdol) were effective in youth with bipolar disorder, but improvements appeared more quickly with risperidone. Risperidone also produced higher response rates, higher remission rates, and fewer dropouts from side effects.
A presentation by the research group at an earlier conference suggested that it was particularly among those with comorbid disruptive behavioral disorders (DBD), which include attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD), that risperidone worked faster and produced greater early results than divalproex.
In the study, 66 children with type I bipolar disorder and a mean age of 11 years were assessed. Treatment with risperidone was initiated at 0.5 mg/day and titrated to 2 mg, while divalproex was initiated at 60 micrograms/mL and titrated up to 120 micrograms.
Editor’s Note: The possibility that children with different comorbid disorders respond differently to different antimanic agents suggests that more studies are needed to determine which subgroups of patients are most responsive to typical treatments.
