Table 1.

Available pharmacological studies on management of inpatient pediatric aggression

STUDY	MEDICATION	ROUTE	TYPE OF STUDY	DIAGNOSES	AGE GROUP	DOSE	FREQUENCY AND DURATION	CLINICAL OUTCOME	SIDE EFFECTS	NO. PATIENTS
Khan et al (2006)20	Ziprasidone (Geodon*)	IM	Retrospective chart review	Bipolar with psychotic features; MDD with psychotic features; psychosis NOS; MDD NOS; substance use/dependence; TSD	Mean age 14.6±2.1 yrs. (included children as well as adolescents)	20mg (15.66±4.35) for children; 20mg (19.45±2.13) for adolescents	PRN	Effective for decreasing aggression	Somnolence, no EKG changes (QTc)	50
Barzman et al (2007)21	Ziprasidone (Geodon*)	IM	Retrospective chart review	Bipolar; MDD; MDD NOS; psychotic disorder; disruptive disorder; ADHD; impulse control disorder	12–19 years	20mg (81% received)	PRN	"Much to very much improved" (81%) "minimally improved" (16%) "no change" (1.3 %) "minimally worse" (1.3%) "much worse" (1.3 %)	Somnolence (60%)	59
Hazarey et al. (2004)22	Ziprasidone (Geodon*)	IM	Case report	CD; ADHD; explosive outburst; GAD; oppositional defiant disorder; bipolar NOS	12–13 years	10mg	PRN	Immediate calming down effect and going to sleep	Syncope—reported only in one patient	3
Stellar et al (2004)23	Ziprasidone (Geodon*)	IM	Retrospective chart review	Not available	8–16 yrs	20mg (87% received)	PRN	Effecitve in management of acute behavioral discontrol	None reported	49
Khan et al (2006)20	Olanzapine (Zyprexa*)	IM	Retrospective chart review	Bipolar with psychotic features; MDD with psychotic features; psychosis NOS; MDD NOS; substance use/dependence; PTSD	13.7±2.4 (included children as well as adolescents)	5mg (5.92±2.18) for children, 10mg (9.17±1.77) for adolescents	PRN	Effective for deacreasing aggression	Drowsiness, no EKG changes ( QTc)	50
Krishnamoorthy et al (1998)25	Olanzapine (Zyprexa*)	PO	Open label	Bipolar, psychosis NOS, schizophrenia, ADHD	6–11 years	7.5mg (22mg/kg)	Daily for 32 days (Range 2–7 weeks)	Better control of aggression in three out of five patients	Sedation, weight gain (upto 16 lbs), akathasia	5
Campbell et al (1984)14	Haloperidol (Haldol*)	PO	Double blind, placebo controlled	CD aggressive type	5.2–12.9 years	1 to 6mg (0.04–0.21mg/kg/day)	Daily for 6 weeks	Superior than placebo to control aggression (made child more manageable)	Drowsiness most common in frequency followed by acute dystonia	61
Buitelaar JK et al (2001)28	Risperidone (Risperdal*)	PO	Double blind, randomized (parallel group design)	Disruptive disorder	adolescents	2.9mg (1.5–4mg)	Daily for 6 weeks	Significant improvement in Overt Aggression Scale	Transient fatigue in more than half of the patients, GI symptoms—nausea, sialorrhea. No EKG changes, no effect on BP	38
Campbell et al (1984)14	Lithium Carbonate (Eskalith*)	PO	Double blind, placebo controlled	CD aggressive type	5.2–12.9 years	500–2000mg (Serum lithium level 0.32–1.51mEq/liter)	Daily for 6 weeks	Superior than placebo to control aggression (reduce explosiveness)	Weight gain more than 30kg, stomachaches, headaches, hand tremors	61
Rifkin et al (1997)15	Lithium Carbonate (Eskalith*)	PO	Double blind, placebo controlled	CD (IQ >70)	12–17 years	Variable dose to maintain blood lithium level of 0.6 to 1mmol/litre	Daily for 2 weeks	No significant effects on decreasing the score in Overt Agression Scale	Side effects due to autonomic system malfunctioning	33
Malone et al (2000)13	Lithium Carbonate (Eskalith*)	PO	Double-blind placebo controlled	CD	Median age 12.7 years	300–2100mg to maintain the level of 0.8–1Mmol/litre	Daily for 4 weeks	Rating on Overt Agression Scale decreased as compared to placebo	GI symptoms: nausea, vomiting and more than 50% patients experiencing increased frequency of urine	40
Vitiello et al (1991)2	Diphenhydramine (Benadryl*)	PO/IM	Double-blind placebo controlled	CD, ADHD, MDD	5–13 years	25–50mg	PRN	IM more effective than PO	Sedation	21
Jangro et al (2009)47	Ziprasidone (Geodon*) vs haloperidol and lorazepam	IM	Retrospective chart review	Substance use/dependence, psychotic disorders, adjustment disorders, impulse control disorder	12–17 years	20mg (82% received) 10mg (18% received)	PRN	There were no differences between the two treatment groups in the outcomes of restraint duration or use of rescue medications	Decreased pulse	52

Abbreviations:

Pts

patients

IM

intramuscular

PO

per oral

MDD

major depressive disorder

NOS

not otherwise specified

yrs

years

PRN

as needed

QTc

QT interval on EKG

BP

blood pressure

H

heart rate

ADHD

attention deficit hyperactivity disorder

CD

conduct disorder

GAD

generalized anxiety disorder

PTSD

posttraumatic stress disorder

GI

gastrointestinal

EKG

electrocardiogram

^*Trade name