Placebo-Controlled Lithium Study of Hospitalized Aggressive Patients With Conduct Disorder

Subject: Psychology
Pages: 5
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Study level: PhD


This was a study conducted by Malone and colleagues in 2000. The researchers wanted to assess the effectiveness of lithium treatment. Its usefulness in the treatment of aggressive behavior in patients had been previously considered. In this study, the authors wanted to see its usefulness in treating such conditions in adolescents and children (Malone, 2000, p. 649). This study was supposed to supplement and support previous studies that had been done on the same issue. Previous studies had suggested that lithium carbonate had been used successfully in the treatment of such behavior in children (Malone, 2000, p. 649). However, there is no agreed-on treatment for the disorder, and it is still subject to further research.

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The authors of the paper were aware of the prevalence of such aggressive behavior in children and adolescents as this had always raised public concern. This behavior in the early years of the development of a child predicted a poor prognosis. It also predicted antisocial behavior in the later (adult years) of the individual. In some adolescents and children, the aggressive behavior may be severe and persist than in others. Studies have been done in order to provide efficient treatment for similar behavior. Other psychopharmacological treatments had also been suggested previously. However, no specific treatment procedure has been generally accepted for this behavior in patients.

The previous study on the use of lithium carbonate had promising results. When administered to the victims, the aggressive behavior was greatly reduced. This worked well for both animals and humans. However, its effectiveness in treating aggression in children and adolescents is questionable and produces inconsistent results. Previous research that performed the double-blind, placebo-controlled study produced mixed results. The study suggested that lithium significantly reduced aggression. However, other studies produced contradictory results. One was conducted on adolescent outpatients and the other on outpatient counterparts. This study yielded negative results. Several other studies have been conducted to assess the effectiveness of lithium for ensuring reduced aggression. Studies determined its efficiency in treating aggression in patients with conduct disorder. Studies on different individuals (such as the elderly) and in different settings also exist. Tools that have been previously used to measure aggression include the Overt Aggression Scale (OAS).

For the current study, Malone and colleagues wanted to conduct a study in the acute-care adolescent and children psychiatric inpatient service, where the children had behavioral disorientation (Malone, 2000, p. 650). Both males and females with a specific level of conduct disorder were included in the study. The age bracket was 10 and 17. The population selected included those patients who were admitted due to having records of previous aggressive behavior. Most of them had shown resistance to previous treatment interventions. For the study, individuals with certain disorders were excluded. These included the mentally retarded, those who had critical depressive disorder, those who were depending on certain drugs, and those with dysthymic disorder. Various other conditions were considered during the selection of a suitable sample for the study.

The study design used for the design was a parallel-groups design. In order to further eliminate unsuitable candidates for the study, the researchers provided an initial single-blind placebo baseline period. This was a period of two weeks. Those who did not meet those criteria were eliminated. Many patients were eliminated after the baseline period in order to reduce discrepancies. Issues such as substance abuse and retardation were not allowed, therefore, those who were determined to be of this nature were eliminated. Those who qualified for the next phase were randomized in order to eliminate biasness. According to the authors, the baseline period was necessary for specific reasons (Malone, 2000, p. 650). One of the reasons for that was in order to allow the patients’ behavior to stabilize. Another reason provided was that it was necessary to ensure the elimination of possible placebo-baseline responders. Lastly, the period was necessary since it provided frequencies and ratings of how severe the aggressions were.

The medical practitioners randomized the patients with the assistance of particular software on the computer. The Overt Aggression Scale ratings were used for the basis of the categorization. The selected sample of patients was put under treatment in order to assess the effectiveness of the drug. The dosages of lithium that were administered to the patients were determined using the methods proposed by researchers in previous studies. Cooper and his colleagues proposed them.

The results of the study suggested that lithium was an effective remedy in the reduction of aggressive behavior in children and adolescents in the hospitals (Malone, 2000, p. 653). These results were valid for specific measures of aggression. According to the Overt Aggression Scale ratings, a significant reduction in aggression was recorded for the group of patients under lithium treatment. However, those who were under placebo treatment did not provide changes in aggression. The researchers concluded that lithium was an effective treatment intervention measure. The hospital team equally agreed. The researchers concluded that lithium was safe for the short-term treatment of aggression in children and adolescent patients. However, the treatment had adverse effects, and this suggests the lack of safety of the medication.

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The study by Malone and colleagues was done well because it was based on sound research. The researchers were able to fill the gaps that had previously been left by other researchers on the same subject. Their study is also complementary with other researches done previously meaning that it is not completely out of place. The research design used was appropriate with the type of study and it also complements those used by other researchers in similar studies.

The methodology employed was also relevant to the study. The method used in the selection of a sample from the population was appropriate since it ensured that biasness was eliminated as much as possible. In order to eliminate confounding variables that would alter the results of the study, the authors introduced a certain criterion that saw to it that the patients who had specific disorders were eliminated from the sample of the study. After the baseline period, those who did not meet the aggression criterion were eliminated (Malone, 2000, p. 650). This meant that only those individuals who qualified for the study were used to provide valid results. The tool used to measure aggression (the Overt Aggression Scale) is a tool that is generally accepted for the particular parameter, and it has successfully been used previously. Therefore, the authors used relevant tools for their study.

During the treatment phase of the study, the researchers determined dosages using the methods that had been proposed by other researchers in previous studies. Therefore, this eliminates biasness and proves relevance. The study also had a longer treatment period as compared to those provided in previous studies (Rifkin and colleagues). This means that there was sufficient time to allow for the full therapeutic effects of the lithium dosages. The researchers in the current study also eliminated the placebo responders after the baseline period in order to eliminate biasness that they could bring into the study. The statistical analyses used were relevant for the study. The statistical packages (software) used were those that are globally acceptable. Therefore, the analyses were accurate. In essence, the results that the research provided were correct based on the results from the analysis.

However, the criterion used for selecting the sample was very tight and it led to the elimination of many individuals who probably showed aggression and conduct disorder. This means that the study was very narrow since it provided a study of a small sample of the entire population and a small group of patients. Initially, the study had selected 86 patients but only 40 qualified (Malone, 2000, p. 649). In other words, the results of the study would not apply to all cases of aggression in patients (adolescents and children). Furthermore, the study was conducted in an inpatient setting. This provided the researchers with a high likelihood of selecting patients with severe aggressive behavior. This would not have been that case if the patients were outpatients. Therefore, there is a need for further research to determine a proper treatment for aggression in patients with disorders such as mental retardation, critical depressive disorders, and those with dysthymic disorders. These studies should also encompass outpatients and not only inpatients. Further research is also required to assess the safety and efficiency of using lithium as a long-term treatment option since the current study lacked a long-term follow-up (Malone, 2000, p. 653).


Malone, R., Delaney, A., Luebbert, J., Cater, J., & Campbell, M. (2000). A double-blind placebo-controlled study of lithium in hospitalized aggressive children and adolescents with conduct disorder. Arch Gen Psychiatry, 57, 649-654.