AFFECTIVE COMORBIDITY IN PSYCHIATRICALLY HOSPITALIZED ADOLESCENTS WITH CONDUCT DISORDER OR OPPOSITIONAL DEFIANT DISORDER - SHOULD CONDUCT DISORDER BE TREATED WITH MOOD STABILIZERS

Two hundred and twenty-three consecutively admitted adolescent inpatie nts were systematically assessed for conduct disorder (CD) and opposit ional defiant disorder (ODD), using the Schedule for Affective Disorde rs and Schizophrenia in School-Aged Children (K-SADS) and DSM-III-R cr iteria. In this suburban private psychiatric hospital, 26% of adolesce nts met criteria for CD, and 12% met criteria for ODD. Whether they ha d CD or not, about two-thirds of these hospitalized adolescents had a mood disorder. In examining specific mood disorders associated with CD , bipolar disorder was significantly more common in patients with CD ( 25%) than in patients without CD (10%). No other mood disorder, includ ing major depression or dysthymia, was more concentrated in the CD sam ple (compared to the non-CD sample). CD patients were also significant ly more likely to have attention-deficient hyperactivity disorder (ADH D) and substance abuse, and significantly less likely to have anxiety disorders. In contrast, hospitalized adolescents with ODD had a much d ifferent pattern of comorbidity, with only a quarter having a mood dis order. In fact, adolescents with ODD were less likely to have a diagno sis of mood disorder than patients without ODD (27% versus 76%). No as sociation was observed between ODD and the presence of ADHD, anxiety d isorder, or substance abuse. These patterns of comorbidity cannot be g eneralized to adolescents in other settings or to children. However, p ending direct pharmacological trials of efficacy, empirical trials of lithium or anticonvulsants in the adolescents with CD appear to be jus tifiable in our sample of psychiatrically hospitalized adolescents, si nce 25% appeared to have bipolar disorder. There was no diagnostic evi dence to encourage attempts at antidepressant treatment of adolescents with CD, apart from the high rate of mood disorders generally seen in hospitalized adolescents. The pharmacological treatment of CD cannot be based purely on comorbidity findings, and must still be subjected t o controlled studies of efficacy.