Nadolol to treat aggression and psychiatric symptomatology in chronic psychiatric inpatients: a double-blind, placebo-controlled study.
BACKGROUND
Considerable evidence indicates that the lipophilic beta-blocker propranolol is useful in treating organically based aggression. This study looked at the efficacy of a more hydrophilic beta-blocker, nadolol, to treat aggression in chronic psychiatric inpatients.


METHODS
Forty-one chronic psychiatric inpatients with an average of one aggressive outburst per week (defined by the Overt Aggression Scale [OAS]) were entered into a double-blind, placebo-controlled study lasting 17 weeks. The OAS was used to track aggression on a per-incident basis, while the Brief Psychiatric Rating Scale (BPRS) and the Clinical Global Impressions scale (CGI) were used to track clinical status.


RESULTS
Nadolol subjects showed a significant decline in frequency of aggression compared with controls (p = .026) and a significant decline in the BPRS total score (p = .007) and in the subfactors "hostility and suspicion," "negative symptoms," and "signs of hyperarousal/tension." There was no significant change in CGI "severity of illness" ratings between groups, although the nadolol group was significantly improved from baseline at every subsequent time period while the placebo group was unchanged throughout the study.


CONCLUSIONS
Nadolol is of significant benefit in the treatment of aggression in chronic psychiatric inpatients. This drug does penetrate the brain over time, but the success of a drug whose primary locus of action is peripheral may implicate a bimodal mechanism of action, i.e., a role for the CNS and the soma in the maintenance of aggression.
Department of Psychiatry, Harvard Medical School, Boston, MA.
J J
JJ
Ratey
P
P
Sorgi
G A
GA
O'Driscoll
S
S
Sands
M L
ML
Daehler
J R
JR
Fletcher
W
W
Kadish
G
G
Spruiell
S
S
Polakoff
K J
KJ
Lindem
D000328:Adult; D000374:Aggression / Q000187:drug effects* / Q000523:psychology; D014150:Antipsychotic Agents / Q000627:therapeutic use; D002908:Chronic Disease; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy* / Q000523:psychology; D009248:Nadolol / Q000627:therapeutic use*; D010919:Placebos; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index
D014150:Antipsychotic Agents; D010919:Placebos; D009248:Nadolol