Impulse Dyscontrol and Aggression Syndromes

Aggressiveness is a common management issue for clinicians of various specialties and may be a primary reason for referral. While aggression is not a specific diagnosis and its etiology should be sought, many of these conditions are not directly treatable, and symptomatic therapy is indicated. A wide assortment of medications in various pharmacological classes have been studied for patients with aggression, primarily in open-label fashion, and none have been found uniformly helpful. In practice, the neuroleptics are the most widely used agents (see T§bIe...3.-2 ). Benzodiazepines are useful for short-term control of aggression, but long-term treatment with these agents should be avoided because of the possibility of paradoxical disinhibition and tolerance necessitating dose escalation. Lithium has been shown to be helpful in the reduction of "psychotic excitement," not only in manic patients but also in those with aggression related to other conditions. Similarly, carbamazepine has been used to stabilize mood and may aid in the treatment of aggressive behaviors. Other agents that may be useful, alone or in combination, include the beta-blockers, clonidine, buspirone, and the serotonin-reuptake inhibitors (fluoxetine, paroxetine). A new class of drugs, termed the serenics, was specifically developed for the treatment of destructive behaviors in humans. However, one such agent, eltoprazine hydrochloride, failed to show any significant effect when it was studied in patients with either Gilles de la Tourette's syndrome or epilepsy with aggressive behaviors.


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