An open trial of sertraline in personality disordered patients with impulsive aggression.
BACKGROUND
Biological studies suggest that an abnormality in CNS serotonergic functioning underlies the impulsive, aggressive, and self-destructive behaviors of personality disordered patients. Preliminary data suggest that these behaviors may respond preferentially to agents with serotonergic-enhancing properties. This study evaluated the effectiveness of sertraline, a serotonin selective reuptake inhibitor, as a treatment for irritability and aggression in personality disordered patients.


METHODS
Eleven patients meeting DSM-III-R criteria for at least one personality disorder were treated with sertraline in an open clinical trial with a flexible dosing schedule. Behavioral ratings for impulsive aggressive behavior and irritability were made at baseline and at Weeks 2, 4, and 8 using a semistructured interview--the Overt Aggression Scale.


RESULTS
Nine of 11 patients completed at least 4 weeks of treatment, and 7 patients completed an 8-week trial. Significant changes from baseline on both irritability and overt aggression were noted by the end of 4 weeks, and improvement continued to occur through Week 8.


CONCLUSIONS
This study suggests that sertraline is an effective treatment for impulsive aggressive behavior in personality disordered patients. It supports the hypothesis that different symptom constellations/personality traits have different underlying biological substrates that may respond differentially to pharmacologic agents with specific modes of action. Controlled studies are needed to evaluate the effectiveness of sertraline and other seronergic agents in the treatment of various dimensions of personality psychopathology.
Kavoussi
R J
RJ
Department of Psychiatry, Medical College of Pennsylvania, Eastern Pennsylvania Psychiatric Institute, Philadelphia 19129.
Liu
J
J
Coccaro
E F
EF
D015057:1-Naphthylamine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000328:Adult; D000374:Aggression / Q000187:drug effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007175:Impulsive Behavior / Q000188:drug therapy* / Q000523:psychology; D007508:Irritable Mood / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D010554:Personality Disorders / Q000188:drug therapy* / Q000523:psychology; D011569:Psychiatric Status Rating Scales; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D020280:Sertraline; D016896:Treatment Outcome
D015057:1-Naphthylamine; D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline