Journal of Psychopharmacology 1–9 © The Author(s) 2016 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0269881116658985 jop.sagepub.com Background As defined by the Diagnostic and Statistical Manual of Mental Disorder, Version 5 (DSM-5) and ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines (ICD-10), conduct disorder (CD) features a diversity of behaviours that may violate societal norms, the basic rights of others and their property (e.g. vandalism, harming animals, setting fires, theft and assault). Of the 15 symptoms of CD that are listed in the DSM-5 (American Psychiatric Association (APA), 2013), only three are required for a diagno- sis. In comparison, the ICD-10 (World Health Organisation (WHO), 1991) includes 23 possible symptoms, but also requires only three included symptoms for diagnosis. The ICD-10 focuses more on the role of socialisation, and features oppositional defi- ant disorder (ODD) as a sub-category of CD, whereas ODD is featured as a separate category in the DSM-5. CD and ODD both involve symptoms that bring the individ- ual into conflict with adults and other authority figures. The behaviours of ODD are typically less severe than those with CD; and do not include aggression toward individuals or animals, destruction of property, or a pattern of theft or deceit. Furthermore, ODD includes problems of emotional dysregulation, such as an angry and irritable mood (APA, 2013). The prevalence of CD, as reported by the Global Burden of Disease Study in 2010, was 3.6% for the male gender (3.3–4.0) and 1.5% (1.4–1.7) for the female gender (Erskine et al., 2013), with those of male gender appearing to have an increased fre- quency and severity of behaviours (Pilling et al., 2013) . The exact aetiology of CD is unknown, but likely to arise from a com- bination of psychosocial, genetic, biological and environmental factors (Nelson et al., 2006); the latter including coercive parent- ing, as described by Patterson et al. (2002). CD is often considered a diagnostic challenge in child and adolescent mental health, due to heterogeneity within the classi- fication and perhaps the high incidence of behavioural comor- bidities that are also present (i.e. attention deficit hyperactivity disorder (ADHD), ODD and depression) (Klahr et al., 2014). In an Australian Government study (Sawyer et al., 2000), approximately 23% of all children and adolescents with CD, ADHD or depression were identified as having a comorbid mental health condition. Overall, those of male gender had a higher rate of comorbidity (27%) than those of female gender (15%). It was reported that only 0.9% of the Australian child and adolescent Pharmacotherapy of conduct disorder: Challenges, options and future directions Jessica L Hambly 1 , Sohil Khan 1,2,3 , Brett McDermott 4 , William Bor 2,5 and Alison Haywood 1,2 Abstract There is a critical need for evaluation of the pharmacotherapies used in conduct disorder (CD), due to the high incidence of off-label prescribing. The aim of this review was to identify concerns associated with the safety, efficacy and impact on quality of life (QOL) that pharmacotherapy has in children and adolescents with CD. A systematic review was undertaken using pre-defined search criteria and four databases, including reference searches. We assessed these studies using the Strength of Recommendation Taxonomy, Grading of Recommendations Assessment, Development and Evaluation, and Review Manager Risk of Bias (RevMan®) tools. There were 12 randomised controlled trials that met our inclusion criteria. Studies included: antipsychotics, atomoxetine, lithium, clonidine, divalproex sodium and psychostimulants. The antipsychotics demonstrated efficacy, but were associated with adverse effects. Other agents demonstrated mixed responses, highlighting the lack of clinical significance and increased incidence of adverse effects. The management of related adverse effects was addressed to assist with clinical gaps. Overall, there is limited evidence regarding the role of pharmacotherapy in CD. More research is needed that takes into account the heterogeneity of CD and analysis of pharmacotherapy in pure CD. Keywords Adverse effects, children, conduct disorder, drugs, efficacy, pharmacotherapy, quality of life, review, safety, young patients, youth 1 School of Pharmacy, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia 2 Mater Research Institute - The University of Queensland, Brisbane, QLD, Australia 3 Manipal College of Pharmaceutical Sciences, Manipal University, Manipal, India 4 Townsville Clinical School, College of Medicine and Dentistry, James Cook University, Queensland, QLD, Australia 5 Child and Youth Mental Health Service, Centre for Children’s Health Research, Queensland Health, Brisbane, QLD, Australia Corresponding author: Sohil Khan, School of Pharmacy, Griffith University, Gold Coast, QLD 4222, Australia. Email: s.khan@griffith.edu.au 658985 Review at Griffith University on July 19, 2016 jop.sagepub.com Downloaded from