The Pharmacotherapy of Human Aggression: A Review

Abstract

Aggression is a common treatment problem that may be associated with several disorders including schizophrenia, schizoaffective disorder, acute mania/bipolar disorder, personality disorders, substance abuse disorders, medical disorders, neurological disorders, and medication misadventures. Aggression is not a linear entity, it is a multidimensional problem influenced by a patient's environment and biological, psychological, and/or neurological status. It follows that if one has a multidimensional treatment problem, then a compre hensive treatment plan must be used to achieve optimal management. The comprehensive treatment of aggression should include a thorough baseline evaluation, regular objective measurement of aggression severity using a rating scale (eg, Overt Aggression Scale), psychological interventions, behavioral interventions, pharmacotherapy and, if necessary, seclusion and/or restraint. The pharmacotherapy of aggres sion includes the traditional antipsychotics and benzodiazepines, which are most commonly used; other pharmacotherapies frequently selected include the β-blockers, carbamazepine, and lithium. Despite these pharmacotherapeutic options and despite a pharmacological rationale for each one, the medications used for the treatment of aggression are at least in part nonspecific for aggression. The nonspecificity of these pharmacotherapies is best exemplified by the common use of multiple drug regimens. This may then lead to drug misadventures either in the form of drug-drug interactions, adverse effects, or toxicity. The serenics are a class of phenylpiperazine compounds that have exhibited some promise as being more selective anti- aggression drugs. Eltoprazine, the first member of this new class, is in early phases of human investigation. Copyright © 1996 by W.B. Saunders Company