A Double-Blind, Randomized, Placebo-Controlled Trial of Fluoxetine in Patients With Intermittent Explosive Disorder

Coccaro, Emil F.; Lee, Royce J.; Kavoussi, Richard J.

doi:10.4088/08m04150

Cited by 26 publications

(32 citation statements)

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“…60, 61 Treatment trials in adults suggest that SSRIs can be beneficial in the treatment of irritability, aggression, and/or explosive outbursts that occur in the context of depression, dysthymic disorder, or anxiety. 62, 63 Pilot data from placebo-controlled trials, while not definitive, could provide some information on the safety and efficacy of SSRIs for children with chronic irritability. In addition, there are no data on efficacy or safety of non-stimulant medications, such as atomoxetine or alpha-adrenergic agonists, in SMD.…”

Section: Evidence For Differentiating Bp-nos and Smdmentioning

confidence: 99%

Differentiating Bipolar Disorder–Not Otherwise Specified and Severe Mood Dysregulation

Towbin¹,

Axelson

Leibenluft³

et al. 2013

Journal of the American Academy of Child & Adolescent Psych

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Objective Bipolar Disorder–Not Otherwise Specified (BP-NOS) and Severe Mood Dysregulation (SMD) are severe mood disorders that were both defined to address questions about the diagnosis of bipolar disorder (BD) in youth. SMD and BP-NOS are distinct phenotypes that differ in clinical presentation and longitudinal course. The purpose of this review is to inform clinicians about the clinical features of the two phenotypes and about the research literature distinguishing them. Method We review the literature on SMD as studied in the National Institute of Mental Health Intramural Research Program and on BP-NOS in youth. For BP-NOS, we focus on the phenotype defined in the Course of Bipolar Youth (COBY) study, since this has received the most study. Results SMD is characterized by impairing, chronic irritability without distinct manic episodes. Most commonly, BP-NOS is characterized by manic, mixed or hypomanic episodes that are too short to meet DSM-IV-TR duration criterion. Research provides strong, albeit suggestive, evidence that SMD is not a form of BD; the most convincing evidence are longitudinal data indicating that youth with SMD are not at high risk to develop BD as they age. The BP-NOS phenotype appears to be on a diagnostic continuum with BD type I and type II. BP-NOS and BD- type I subjects have similar symptom and family history profiles, and youth with BP-NOS are at high risk to develop BD as they age. Currently, little research guides treatment for either phenotype. Conclusions Pressing research needs include identifying effective treatments for these phenotypes, ascertaining biomarkers that predict conversion from BP-NOS to BD, elucidating associations between SMD and other disorders, and defining the neural circuitry mediating each condition.

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Section: Evidence For Differentiating Bp-nos and Smdmentioning

confidence: 99%

Differentiating Bipolar Disorder–Not Otherwise Specified and Severe Mood Dysregulation

Towbin¹,

Axelson

Leibenluft³

et al. 2013

Journal of the American Academy of Child & Adolescent Psych

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“…It is estimated that 4–7% of people in the United States have IED and usually meet diagnostic criteria during adolescence (ages 14–18; Coccaro et al, 2004; Kessler et al, 2006; Coccaro, 2010). Some clinical studies suggest that the majority (77–87.5%) of individuals with IED are males (Mattes, 2008; Coccaro et al, 2009), however a community sample of 253 individuals found only 37.5% were male (Coccaro et al, 2004). The first outburst typically occurs in early adolescence and people with IED have an average of 43 lifetime attacks resulting in $1359 in property damage (Kessler et al, 2006).…”

Section: Core Characteristics Of Impulse Control Disordersmentioning

confidence: 99%

“…Despite a large decrease in impulsive aggression behavior from baseline, only 44% of fluoxetine responders and 29% of all fluoxetine subjects were considered to be in full remission at the end of the study (Coccaro et al, 2009). …”

Section: Pharmacological Treatmentmentioning

confidence: 99%

Impulse Control Disorders: Updated Review of Clinical Characteristics and Pharmacological Management

Schreiber¹,

Odlaug²,

Grant³

2011

Front. Psychiatry

125

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Impulse control disorders (ICDs) are characterized by urges and behaviors that are excessive and/or harmful to oneself or others and cause significant impairment in social and occupational functioning, as well as legal and financial difficulties. ICDs are relatively common psychiatric conditions, yet are poorly understood by the general public, clinicians, and individuals struggling with the disorder. Although ICD treatment research is limited, studies have shown ICDs may respond well to pharmacological treatment. This article presents a brief overview about the clinical characteristics of ICDs and pharmacological treatment options for individuals with ICDs.

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“…Studies of CSF 5-HIAA concentration and physiologic responses to 5-HT stimulation are not as conclusive in human studies. CSF 5-HIAA concentration adjusted for CSF HVA concentration ; see PRL[Fen] adjusted for several covariates and composite aggression scores (see Coccaro et al 2009). PRL [Fen], in human subjects.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, a twin study reported that both affective intensity and affective lability are under significant genetic influence and, accordingly, both aspects of affective instability have an underlying biological substrate. In these individuals, serotonin appears to inhibit intense anger and its resulting aggressive action against the object of that anger (Coccaro et al 2009. Work in the related area of anger and aggression suggests that central levels of serotonin play an important role in the regulation of anger and aggression, particularly in subjects with personality disorders (Coccaro & Siever, 2005).…”

Section: Introductionmentioning

confidence: 99%

Cerebrospinal fluid 5-hydroxyindolacetic acid correlates directly with negative affective intensity, but not affective lability, in human subjects

Coccaro

Boparai

Lee

2012

International Journal of Neuropsychopharmacology

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Centrally acting monoamines have long been thought to be associated with component traits of behavior and emotion and are potential biological mediators of psychopathology. In this study we tested the hypothesis that centrally acting monoamines would be associated with measures of affective instability (i.e. affective intensity and affective lability) in healthy and personality disordered human subjects. In total, 57 adult subjects including 19 psychiatrically healthy volunteers and 38 personality disordered individuals were assessed for affective instability with the affective intensity measure (AIM) and the Affective Lability Scale (ALS). Samples of cerebrospinal fluid (CSF) were collected for assay of 5-hydroxyindoleacitic acid (5-HIAA), homovanillic acid (HVA) and 3-methoxy-4-hydroxy-phenylglycol (MHPG). CSF 5-HIAA concentration correlated directly with overall AIM score and, specifically, with the AIM Negative Intensity score, in all subjects and in personality disordered subjects. This result was not affected but the addition of aggression scores or life history of mood disorder to the model. Neither CSF HVA nor MHPG were found to uniquely correlate with either AIM or ALS measure. Higher Affective Intensity scores, Negative Intensity scores, specifically, are directly correlated with higher basal levels of CSF 5-HIAA. This relationship was independent of aggression, life history of mood disorder and general personality traits.

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A Double-Blind, Randomized, Placebo-Controlled Trial of Fluoxetine in Patients With Intermittent Explosive Disorder

Cited by 26 publications

References 0 publications

Differentiating Bipolar Disorder–Not Otherwise Specified and Severe Mood Dysregulation

Differentiating Bipolar Disorder–Not Otherwise Specified and Severe Mood Dysregulation

Impulse Control Disorders: Updated Review of Clinical Characteristics and Pharmacological Management

Cerebrospinal fluid 5-hydroxyindolacetic acid correlates directly with negative affective intensity, but not affective lability, in human subjects

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