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Divalproex Treatment for Youth With Explosive Temper and Mood Lability: A Double-Blind, Placebo-Controlled Crossover Design
Abstract
OBJECTIVE: The authors sought to replicate open-label findings showing that specific criteria for explosive temper and mood lability identify disruptive youth who improve while receiving the anticonvulsant divalproex sodium. METHOD: Twenty outpatient children and adolescents (ages 10-18) with a disruptive behavior disorder (oppositional defiant disorder or conduct disorder) met the specific criteria for explosive temper and mood lability. They received 6 weeks of divalproex treatment and 6 weeks of placebo by random assignment. Independent evaluators blind to group assignment assessed response at the end of each phase. RESULTS: At the end of phase 1, eight of 10 subjects had responded to divalproex; zero of 10 had responded to placebo. Of the 15 subjects who completed both phases, 12 has superior response taking divalproex. CONCLUSIONS: This preliminary study replicates open-label findings showing that divalproex is an efficacious treatment for explosive temper and mood lability in disruptive children and adolescents.
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“However, a comparison of behavior therapy combined with either divalproex or stimulants found that the use of divalproex was more efficacious in children with severe aggressive behavior, most of whom also had ADHD (118).”
From Emotion Dysregulation in Attention Deficit Hyperactivity Disorder (2014) · cites this paper as [118]
In the citing paper
“Divalproex was found it to be superior to placebo in treating explosive temper, mood lability [661], and CD [662] in adolescents.”
From Reward circuitry dysfunction in psychiatric and neurodevelopmental disorders and genetic syndromes: animal models and clinical findings (2012) · cites this paper as [661]
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“Improved behavioral dyscontrol and aggression with DVP has also been noted in patients with post-traumatic stress disorder [38-40], temper outbursts [36,37,41], traumatic brain injury [42,43], dementia [31,44-46], and autism [47].”
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한국형 주의력결핍 과잉행동장애 약물치료 알고리듬 개발을 위한 예비연구
박재홍, 김붕년, 김재원, Kim, J. H., 손정우, 신동원, 신윤미, 양수진, 유한익, 유희정, et al. (2011) · AJOU Open Repository (Ajou University) · Cited by 3
Psychopharmacology for the Violent Adolescent
Calles, J. L. (2006) · Primary Care Clinics in Office Practice · doi:10.1016/j.pop.2006.01.002 · Cited by 3
Conduct disorder and other disruptive behaviors: Pediatric psychopharmacology
Jensen, J. B. (2004) · Current Psychosis & Therapeutics Reports · doi:10.1007/bf02629429 · Cited by 3
“The results demonstrated that for 15 of 20 children who completed this study, 12 responded positively in mood lability and aggression [ 30 ].”
Background(2021) · Wiley eBooks · doi:10.1002/9781119870203.mpg005 · Cited by 3
Donovan, S. J., & Levin, F. R. (2011) · The American Journal of Drug and Alcohol Abuse · doi:10.3109/00952990.2011.569805 · Cited by 5
“We found that, as in previous studies of aggression (9), peers were impractical and junior high school teachers were unresponsive, but parents and adolescent were able to reach consensus on ADHD symptoms as long as the questions were not seen as a venue to deliver criticism.”
MethodResultSelf-citationAggression, Gewalt, Amok, Stalking infolge psychischer Störungen
Bogerts, B., Peter, E., & Schiltz, K. (2017) · Springer eBooks · doi:10.1007/978-3-662-49295-6_94 · Cited by 2
Current Perspectives on the Pharmacologic Treatment of Pediatric Aggression
Stepanova, E., & Findling, R. L. (2025) · Psychiatric Annals · doi:10.3928/00485713-20250730-03 · Cited by 2
Conduct Disorder and Oppositional Defiant Disorder
Goldstein, M. L., & Morewitz, S. J. (2011) · Springer eBooks · doi:10.1007/978-1-4419-9764-7_7 · Cited by 2
Park, J.-H., Kim, B.-N., Kim, J.-W., Kim, J., Son, J.-W., Shin, D., Shin, Y.-M., Yang, S., Yoo, H., Yoo, H., et al. (2011) · Journal of korean Academy of Child and Adolescent Psychiatry · doi:10.5765/jkacap.2011.22.1.025 · Cited by 5
The treatment of bipolar patients with elevated impulsivity and suicide risk
Sloan, M. E., Iskric, A., & Low, N. C. P. (2014) · Journal of Psychiatry and Neuroscience · doi:10.1503/jpn.130274 · Cited by 2
Wolfson, J. A., & Henn, L. L. (2014) · Emerging Themes in Epidemiology · doi:10.1186/1742-7622-11-14 · Cited by 2
“Donovan SJ: Divalproex treatment for youth with explosive temper and mood lability: a double-blind, placebo-controlled crossover design.”
Method
Metadata
- Authors
- Donovan, S. J., Stewart, J. W., Nunes, E. V., Quitkin, F. M., Parides, M., Daniel, W., Susser, E., & Klein, D. F.
- Affiliations
- New York State Psychiatric Institute (US)
- Venue
- American Journal of Psychiatry
- Published
- 2000-05-01
- Volume
- 157
- Issue
- 5
- Pages
- 818-820
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- OpenAlex
- W2154371517
- Cited by
- 273
- References
- 6
- Citations by year
- 2025: 7 · 2024: 4 · 2023: 6 · 2022: 5 · 2021: 7 · 2020: 2 · 2019: 2 · 2018: 5 · 2017: 12 · 2016: 18 · 2015: 7 · 2014: 10 · 2013: 2 · 2012: 9
- FWCI
- 20.93
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute on Drug Abuse (DA00246)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Keywords
- divalproex sodium, valproic acid, emotional lability, disruptive behavior disorders, oppositional defiant disorder, conduct disorder, children and adolescents, anticonvulsant therapy, placebo response, replication
- MeSH terms
- Adolescent, Ambulatory Care, Anticonvulsants, Child, Double-Blind Method, Drug Administration Schedule, Female, Humans, Disruptive, Impulse Control, and Conduct Disorders, Male, Placebos, Psychiatric Status Rating Scales, Valproic Acid, Comorbidity, Treatment Outcome, Cross-Over Studies, Attention Deficit and Disruptive Behavior Disorders, Mood Disorders
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