A double-blind placebo-controlled study of lithium in hospitalized aggressive children and adolescents with conduct disorder

Background: A subgroup of children and adolescents with conduct disorder ar e characterized by severe and persistent aggression. Although there is no a greed on treatment for such aggression, lithium carbonate has shown promise in some studies involving children. Our study was designed to critically a ssess the efficacy of lithium in the treatment of aggression in children an d adolescents using a measure specific for aggression. Methods: Subjects were inpatients with conduct disorder hospitalized becaus e of severe and chronic aggression. A parallel-groups design was used in th is double-blind, placebo-controlled trial with randomization to lithium or placebo. Only those who met the aggression criterion during the 2-week plac ebo-baseline period were randomized to 4 weeks of treatment. Outcome measur es included Clinical Global Impressions, the Global Clinical Judgements (Co nsensus) Scale, and the Overt Aggression Scale. Results: Eighty-six inpatients enrolled in the study; 40 (33 male and 7 fem ale; median age, 12.5 years) entered and completed the treatment phase. Lit hium was statistically and clinically superior to placebo. Sixteen of 20 su bjects in the lithium group were responders on the Consensus ratings vs 6 o f 20 in the placebo group (P = .004). Ratings on the Overt Aggression Scale decreased significantly for the lithium group vs the placebo group (P = .0 4). More than half of the subjects in the lithium group experienced nausea, vomiting, and urinary frequency. Conclusions: Lithium is a safe and effective short-term treatment for aggre ssion in inpatients with conduct disorder, although its use is associated w ith adverse effects.