22.1 Can Pediatric Bipolar Disorder be Successfully Treated When Comorbid With Conduct Disorder? A Secondary Analysis of Six Clinical Trials of Second Generation Antipsychotics

Abstract

Pediatric bipolar disorder (BP) is highly comorbid with conduct disorder (CD) and its presence adds to the high morbidity of BP disorder. While there are no known pharmacological treatments for CD, pediatric BP is responsive to treatment. Yet, it is not known whether antimanic treatments remain efficacious in the context of comorbid CD. The main aim of this secondary analysis study was to examine whether pediatric BP responds to second-generation antipsychotics (SGAs) when comorbid with CD. This finding could have important clinical and public health significance by providing a pharmacological option for this highly morbid comorbid condition. We conducted a secondary analysis of 6 prospective 8-week open-label trials of second-generation antipsychotics (SGAs; risperidone, olanzapine, quetiapine, ziprasidone, and aripiprazole) using identical methodology in youth with BP with and without comorbid CD. Of 165 youths with BP, 54% (N = 89) met criteria for comorbid CD. The antimanic effects observed were almost identical in BP youths with and without comorbid CD, as measured either by a reduction in Young Mania Rating Scale (YMRS) ≥30% or Clinical Global Impression (CGI)-Improvement scale ≤2 (p = 0.23), or by the more stringent definition of a reduction in YMRS ≥50% (p = 0.61). Pediatric BP can be effectively treated with SGAs in the context of comorbid CD. Based on previous research showing that remission of BP is associated with remission of CD, if confirmed, these findings raise the possibility that antimanic treatment of youth with BP comorbid with CD could have secondary benefits in mitigating the morbidity associated with CD.