The panel recommended that future clinical trials examine atypical antipsychotic efficacy in treating different subtypes of aggression. They also suggested that subjects should be divided by age group (e.g., 8 through 12 versus 13 through 18) to determine if the groups respond differently to medication choices. The panel also recommended directly comparing atypical antipsychotics for safety and tolerance and comparing mood stabilizers to atypical antipsychotics. In addition, the panel recommended that additional studies be conducted with b-blockers and with combinations of medication classes.
"When one considers the frequency with which aggressive youth are treated with psychotropic medications, as well as the gaps in our knowledge of the long-term safety and efficacy of these practices, it is clear that controlled trials are urgently needed in this area" (Schur et al., 2003).
The panel developed 14 main recommendations for the treatment phases of evaluation, acute treatment, stabilization and maintenance (Due to copyright restrictions, this Figure cannot be reprinted online. Please see p7 of the print edition-Ed).
The panel recommended a comprehensive psychiatric diagnostic interview with all new patients and their parents/guardians before prescribing, changing or discontinuing medication. The panel cautioned that medication adjustments before adequate evaluation can confound diagnosis.
"Clinicians should use ... [clinical] information along with the diagnostic interview to develop a conceptual-etiological model and clinical formulation of the patient's problems, and use these hypotheses to guide all interventions, including the use of medications" (Pappadopulos et al., 2003).
The panel recommended utilizing standardized, validated rating scales of target symptoms, such as the Modified Overt Aggression Scale (MOAS), early and periodically throughout treatment to inform intervention strategy and assess outcome.
"The systematic, routine tracking of target symptoms in severely disturbed youth with complex behavior problems holds the promise of optimizing treatments" (Pappadopulos et al., 2003).
The panel considered psychosocial and educational interventions as first-line treatments and recommended their continuation with any required medication. An ideal therapeutic milieu, in the panel's judgment, includes contingency management programs, skills training programs, individualized interventions and psychoeducational programs.