title: Treating the violent patient with psychosis or impulsivity utilizing antipsychotic polypharmacy and high-dose monotherapy.
abstract: Insufficient treatment of psychosis often manifests as violent and aggressive behaviors that are dangerous to the patient and others, and that warrant treatment strategies which are not considered first-line, evidence-based practices. Such treatment strategies include both antipsychotic polypharmacy (simultaneous use of 2 antipsychotics) and high-dose antipsychotic monotherapy. Here we discuss the hypothesized neurobiological substrates of various types of violence and aggression, as well as providing arguments for the use of antipsychotic polypharmacy and high-dose monotherapy to target dysfunctional neurocircuitry in the subpopulation of patients that is treatment-resistant, violent, and aggressive. In this review, we focus primarily on the data supporting the use of second-generation, atypical antipsychotics both at high doses and in combination with other antipsychotics.
authors.affiliation: 1Neuroscience Education Institute,Carlsbad,CA,USA.
authors.forename: Debbi A
authors.initials: DA
authors.lastname: Morrissette
authors.affiliation: 1Neuroscience Education Institute,Carlsbad,CA,USA.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Stahl
mesh_terms: D014150:Antipsychotic Agents / Q000627:therapeutic use*; D000068180:Aripiprazole / Q000627:therapeutic use; D001569:Benzodiazepines / Q000627:therapeutic use; D001921:Brain / Q000378:metabolism; D003024:Clozapine / Q000627:therapeutic use; D003986:Dibenzocycloheptenes; D004359:Drug Therapy, Combination; D006576:Heterocyclic Compounds, 4 or More Rings / Q000627:therapeutic use; D006801:Humans; D007175:Impulsive Behavior; D007555:Isoxazoles / Q000627:therapeutic use; D000069056:Lurasidone Hydrochloride / Q000627:therapeutic use; D000077152:Olanzapine; D000068882:Paliperidone Palmitate / Q000627:therapeutic use; D010879:Piperazines / Q000627:therapeutic use; D010880:Piperidines / Q000627:therapeutic use; D019338:Polypharmacy; D011618:Psychotic Disorders / Q000188:drug therapy* / Q000378:metabolism / Q000523:psychology; D000069348:Quetiapine Fumarate / Q000627:therapeutic use; D017448:Receptors, Dopamine D2 / Q000378:metabolism; D018967:Risperidone / Q000627:therapeutic use; D013844:Thiazoles / Q000627:therapeutic use; D014754:Violence / Q000145:classification / Q000517:prevention & control* / Q000523:psychology
chemical_list: D014150:Antipsychotic Agents; C581293:DRD2 protein, human; D003986:Dibenzocycloheptenes; D006576:Heterocyclic Compounds, 4 or More Rings; D007555:Isoxazoles; D010879:Piperazines; D010880:Piperidines; D017448:Receptors, Dopamine D2; D013844:Thiazoles; D001569:Benzodiazepines; D000069348:Quetiapine Fumarate; C092292:ziprasidone; D000068180:Aripiprazole; D003024:Clozapine; C522667:asenapine; D018967:Risperidone; D000077152:Olanzapine; D000069056:Lurasidone Hydrochloride; D000068882:Paliperidone Palmitate; C081732:iloperidone