Psychopharmacology of Persistent Violence and Aggression.
Persistent violence not due to acute psychosis or mania can be managed only after appropriate characterization of the aggressive episodes (psychotic, impulsive, or predatory/planned/instrumental). The type of violence combined with the psychiatric diagnosis dictates the evidence-based pharmacologic approaches for psychotically motivated and impulsive aggression, whereas instrumental violence mandates forensic/behavioral strategies. For nonacute inpatients, schizophrenia spectrum disorders, traumatic brain injury, and dementia comprise the majority of individuals who are persistently aggressive, with impulsive actions the most common form of violence across all diagnoses. Neurobiological considerations combined with empirical data provide a comprehensive framework for systematic medication trials to manage persistently aggressive patients.
California Department of State Hospitals (DSH), Psychopharmacology Resource Network, DSH-Patton, 3102 East Highland Avenue, Patton, CA 92369, USA; Department of Psychiatry, University of California, San Diego; 9500 Gilman Drive, MC 0603, La Jolla, CA 92093-0603, USA. Electronic address: jmmeyer@ucsd.edu.
Jonathan M
JM
Meyer
California Department of State Hospitals (DSH), Psychopharmacology Resource Network, DSH-Patton, 3102 East Highland Avenue, Patton, CA 92369, USA.
Michael A
MA
Cummings
California Department of State Hospitals (DSH), Psychopharmacology Resource Network, DSH-Patton, 3102 East Highland Avenue, Patton, CA 92369, USA.
George
G
Proctor
Department of Psychiatry, University of California, San Diego; 9500 Gilman Drive, MC 0603, La Jolla, CA 92093-0603, USA; California Department of State Hospitals (DSH), Bateson Building, 1600 9th Street, Room 400, Sacramento, CA 95814, USA.
Stephen M
SM
Stahl
D000374:Aggression / Q000523:psychology*; D018692:Antimanic Agents; D014150:Antipsychotic Agents / Q000627:therapeutic use; D000070642:Brain Injuries, Traumatic / Q000188:drug therapy; D002220:Carbamazepine / Q000627:therapeutic use; D003024:Clozapine / Q000627:therapeutic use; D003704:Dementia; D006801:Humans; D007175:Impulsive Behavior / Q000502:physiology; D009446:Neurobiology; D011600:Psychopharmacology / Q000379:methods*; D011618:Psychotic Disorders / Q000188:drug therapy; D012559:Schizophrenia / Q000188:drug therapy; D014754:Violence / Q000523:psychology*
D018692:Antimanic Agents; D014150:Antipsychotic Agents; D002220:Carbamazepine; D003024:Clozapine
Aggression; Impulsivity; Pharmacology; Violence