PHARMACOTHERAPY OF AGGRESSIVE-BEHAVIOR

OBJECTIVE: To review the definition, clinical characteristics, prevale nce, etiology, neurochemistry, and pharmacologic treatment of aggressi ve behavior, and provide recommendations regarding the use of specific pharmacologic agents for treating aggressive behavior. DATA SOURCES: Data from the scientific literature were analyzed, interpreted, and su mmarized. An English-language MEDLINE search yielded clinical trials, case reports, letters, and review articles addressing the etiology and pharmacotherapy of aggression. STUDY SELECTION: Because few well-cont rolled studies are available in aggression research, all literature ad dressing the pharmacologic treatment of aggressive behavior, as well a s the neurochemistry and psychobiology of aggressive behavior, was rev iewed. DATA EXTRACTION: The literature was reviewed on the basis of th e particular pharmacotherapy and the specific population used. A separ ate review of the treatment of aggressive behavior in the elderly was included. DATA SYNTHESIS: The literature was assessed for applicabilit y to clinical practice and usefulness to the general clinician. Recomm endations were made from the primary literature in conjunction with tr ends in clinical practice. Pharmacotherapy is a primary mainstay of tr eatment for aggressive patients. In individuals for whom behavioral in tervention alone is unsuccessful, drug therapy should be initiated alo ng with continued nonpharmacologic intervention. Short-acting benzodia zepines and high-potency antipsychotic agents are effective in treatin g acute aggression on a short-term or as needed basis. Agents such as lithium, beta-adrenergic blockers, carbamazepine, valproic acid, buspi rone, trazodone, serotonin reuptake inhibitors, and clozapine may be u seful in the chronic management of aggressive behavior. Every attempt should be made to streamline drug therapy in patients with chronic agg ression and comorbid psychiatric disorders. CONCLUSIONS: On the basis of available research and extensive clinical experience, lithium or pr opranolol should be considered as first-line antiaggressive agents in patients without comorbid psychiatric disorders. A minimum trial perio d for assessing drug efficacy should last at least 6-8 weeks at maximu m tolerated dosages. Patients responding to pharmacotherapy should be reevaluated every 3-6 months, and periodic medication tapers and/or dr ug-free periods should be attempted.