title: Efficacy of mood stabilisers in the treatment of impulsive or repetitive aggression: systematic review and meta-analysis.
abstract: BACKGROUND
  Individuals with repetitive or impulsive aggression in the absence of other disorders may be diagnosed with intermittent explosive disorder according to DSM-IV, but no such diagnostic category exists in ICD-10. Mood stabilisers are often used off-license for the treatment of aggression associated with a variety of psychiatric conditions, but their efficacy in these and in idiopathic aggression is not known.
  
  
  OBJECTIVE
  To summarise and evaluate the evidence for the efficacy of mood stabilisers (anticonvulsants/lithium) in the treatment of impulsive or repetitive aggression in adults.
  
  
  METHODS
  A meta-analysis of randomised controlled trials that compared a mood stabiliser with placebo in adults without intellectual disability, organic brain disorder or psychotic illness, identified as exhibiting repetitive or impulsive aggression.
  
  
  RESULTS
  Ten eligible trials (489 participants) were identified A pooled analysis showed an overall significant reduction in the frequency/severity of aggressive behaviour (standardised mean difference (SMD) = -1.02, 95% CI -1.54 to -0.50), although heterogeneity was high (I(2) = 84.7%). When analysed by drug type, significant effects were found in the pooled analysis of three phenytoin trials (SMD = -1.34, 95% CI -2.16 to -0.52), one lithium trial (SMD = -0.81, 95% CI -1.35 to -0.28), and two oxcarbazepine/carbamazepine trials (SMD = -1.20, 95% CI -1.83 to -0.56). However, when the results of only those studies that had a low risk of bias were pooled (347 participants), there was no significant reduction in aggression (SMD = -0.28, 95% CI -0.73 to 0.17, I(2) = 71.4%).
  
  
  CONCLUSIONS
  There is evidence that mood stabilisers as a group are significantly better than placebo in reducing aggressive behaviour, but not all mood stabilisers appear to share this effect. There is evidence of efficacy for carbamazepine/oxcarbazepine, phenytoin and lithium. Many studies, however, were at risk of bias and so further randomised controlled trials are recommended.
authors.affiliation: Department of Psychological Medicine and Neurology, School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN. jonesrm6@cf.ac.uk
authors.forename: Roland M
authors.initials: RM
authors.lastname: Jones
authors.forename: James
authors.initials: J
authors.lastname: Arlidge
authors.forename: Rebecca
authors.initials: R
authors.lastname: Gillham
authors.forename: Shuja
authors.initials: S
authors.lastname: Reagu
authors.forename: Marianne
authors.initials: M
authors.lastname: van den Bree
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Taylor
mesh_terms: D000328:Adult; D000374:Aggression / Q000187:drug effects* / Q000523:psychology; D000927:Anticonvulsants / Q000627:therapeutic use*; D018692:Antimanic Agents / Q000627:therapeutic use*; D007174:Disruptive, Impulse Control, and Conduct Disorders / Q000188:drug therapy*; D006801:Humans; D018020:Lithium Compounds / Q000627:therapeutic use*; D008297:Male; D010919:Placebos; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants; D018692:Antimanic Agents; D018020:Lithium Compounds; D010919:Placebos