Cr. Pfeffer et al., BUSPIRONE TREATMENT OF PSYCHIATRICALLY HOSPITALIZED PREPUBERTAL CHILDREN WITH SYMPTOMS OF ANXIETY AND MODERATELY SEVERE AGGRESSION, Journal of child and adolescent psychopharmacology, 7(3), 1997, pp. 145-155
Open-label buspirone was studied in 25 prepubertal psychiatric inpatie
nts (age 8.0 +/- 1.8 years, 76% boys) presenting with anxiety symptoms
and moderately aggressive behavior. Patients with severe aggression,
requiring rapid treatment with mood stabilizers or neuroleptics, were
excluded. A 3-week titration (maximum 50 mg daily) preceded a 6-week m
aintenance phase at optimal dose. Buspirone was discontinued in 6 chil
dren (25%): 4 developed increased aggression and agitation, and 2 deve
loped euphoric mania. For the 19 patients who completed the study, mea
n optimal dose was 28 mg daily. Among completers, depressive symptoms
were reduced 52% by Week 6 on Children's Depression Inventory (p less
than or equal to 0.001). Decreased aggressivity was reflected in a 29%
reduction on Measure of Aggression, Violence, and Rage in Children [M
AVRIC] ratings (p less than or equal to 0.02) and in 86% less time in
seclusion or physical restraints (p less than or equal to 0.02). Clini
cal Global Assessment scores improved (CGAS 41 vs. 54, p less than or
equal to 0.01). Only 3 children improved sufficiently to continue busp
irone after the study. Residual aggressivity and global functioning re
mained problematic. Buspirone may pose behavioral risks in treating mo
derate aggressivity in 24% of children with anxiety; in the others, th
e therapeutic effects on aggression, anxiety, and depression were limi
ted but significant.