Violent behavior in psychiatric patients may result in long-term hospitalization. There is no FDA-approved psychopharmacologic treatment for aggression. In this study, 20 chronically aggressive hospitalized patients were administered 1 week of placebo followed by an open trial of increasing doses of propranolol. Patients who had an equivocal or definite clinical response were entered into an open add-on double-blind discontinuation study phase. Aggressive behavior was objectively documented throughout the study. After the open phase of the study, 7 patients had a greater than 50% decrease in aggressive behavior. Four patients entered the double-blind discontinuation phase. The clinical course of 3 of those patients was consistent with the positive response to propranolol. The results of this study are consistent with a therapeutic effect of propranolol in some patients with aggressive behavior. Further studies are indicated.

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The development of children and adolescents is characterized by abrupt discontinuities as well as continuous aspects of behavior such as individual temperament. The crucial task of the first year of life is the development and solidification of the attachment between infant and caretaker. Toddlers and adolescents tend to experience intense conflicts around autonomy and control that become resolved as they progress in the process of separation-individuation. The tasks of middle childhood include developing a sustained sense of mastery and competence, morality, and stable self-esteem; as ego functions grow and consolidate, children become increasingly able to tolerate frustration and delays in the gratification of their wishes and desires. Adolescence begins with puberty, the period of sexual maturation in which the primary sex organs develop and become capable of reproduction and secondary sex characteristics appear. Although adolescents tend to engage in risk-taking behaviors, the majority of adolescents maintain normal academic and social functioning; an adolescent whose rebelliousness includes severe disturbances in conduct, mood, or drug abuse should be evaluated for possible psychopathology requiring treatment. The main social developmental tasks for adults take place in the realms of work and intimate relationships.