Fluoxetine and impulsive aggressive behavior in personality-disordered subjects.
BACKGROUND
Evidence of an inverse relationship between central serotonergic (serotonin [5-hydroxytryptamine]) system function and impulsive aggressive behavior has been accumulating for more than 2 decades. If so, pharmacological enhancement of serotonin activity should be expected to reduce impulsive aggressive behavior in subjects in whom this behavior is prominent.


METHODS
A double-blind, placebo-controlled trial of the selective serotonin-uptake inhibitor fluoxetine hydrochloride was conducted in 40 nonmajor-depressed, nonbipolar or schizophrenic, DSM-III-R personality-disordered individuals with current histories of impulsive aggressive behavior and irritability. Measures included the Overt Aggression Scale-Modified for Outpatients, Clinical Global Impression Rating of Improvement, and several secondary measures of aggression, depression, and anxiety.


RESULTS
Fluoxetine, but not placebo, treatment resulted in a sustained reduction in scores on the Irritability and Aggression subscales of the Overt Aggression Scale-Modified for Outpatients that was first apparent during months 2 and 3 of treatment, respectively. Fluoxetine was superior to placebo in the proportion of "responders" on the Clinical Global Impression Rating of Improvement: first at the end of month 1, and then finally demonstrating a sustained drug-placebo difference from the end of month 2 through the end of month 3 of treatment. These results were not influenced by secondary measures of depression, anxiety, or alcohol use.


CONCLUSIONS
Fluoxetine treatment has an antiaggressive effect on impulsive aggressive individuals with DSM-III-R personality disorder.
Coccaro
E F
EF
Department of Psychiatry, Hahnemann School of Medicine, Allegheny University of the Health Sciences, Philadelphia, Pa., USA.
Kavoussi
R J
RJ
D000328:Adult; D000374:Aggression / Q000187:drug effects*; D004311:Double-Blind Method; D005473:Fluoxetine / Q000031:analogs & derivatives / Q000097:blood / Q000493:pharmacokinetics / Q000627:therapeutic use*; D006801:Humans; D007175:Impulsive Behavior / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D010352:Patient Dropouts; D010554:Personality Disorders / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology; D010919:Placebos; D011569:Psychiatric Status Rating Scales; D012701:Serotonin / Q000502:physiology; D016896:Treatment Outcome
D010919:Placebos; D005473:Fluoxetine; D012701:Serotonin; C036139:norfluoxetine