Beta Blockers for Aggression: A Review of the Pediatrie Experience

Abstract

beta-Adrenergic blocking agents have been used successfully to treat intractable aggression in adult psychiatric patients. A review of the adult literature and a summary of the pediatrie treatment experience are presented. There are no double-blind placebo-controlled studies in child or adolescent psychiatric patients. Open studies have reported high improvement rates (75-85%), but actual improvement rates may be lower than the generally uncontrolled reports in the literature suggest to date. Future controlled studies should take advantage of statistical methods that allow determination of meaningful changes within subjects in addition to the more typically analyzed changes within groups. Though these medications may be effective as adjunctive treatments in a multidisciplinary approach to aggression, beta blockers cannot at present be considered to be indicated in the treatment of any child or adolescent psychiatric disorder. There is not enough available information to know whether aggression that is associated with any specific psychiatric diagnosis is predictive of response to beta blockers in children or adolescents, and no other predictors of treatment response have been consistently identified. Judging from the experience in adults, treatment duration may be more important than dose level in attaining a therapeutic response with beta blockers. Empirical clinical and research trials of beta blockers for psychiatric symptoms or disorders should probably be run for a minimum of 12 weeks.

Prevalence and Patterns of Psychotropic and Anticonvulsant Medication Use in Children and Adolescents Referred to Residential Treatment

“…In addition to the controlled research supporting the efficacy of lithium in treating aggressive conduct disorder , there is a growing literature consisting of case reports and open studies describing the use of beta-adrenergic blockers for aggression in the developmentally-delayed and organic brain-damaged pédiatrie population (Connor 1993;, clonidine for aggression associated with disruptive behavior disorders (Hunt et al 1990), and stimulants in aggressive-hyperactive boys (Gadow et al 1990), as well as the importance of serotonin in aggressive behavior in psychiatrically referred youth (Kruesi et al 1992;Zubieta and Alessi 1993). However, other types of medications appeared rarely prescribed for aggression in our study population.…”

Biological Treatment of Asperger'sDisorder

“…In addition, betablockers have membrane-stabilizing effects and GABAmimetic activity that may contribute to their benefit not only for anxiety, but also for aggressive behavior in individuals with autism, ADHD, posttraumatic stress disorder (PTSD), and organic brain dysfunction (26,28,29). The average recommended dose is 0.5 to 1.0 mg/kg/day administered in divided doses q6to 8 hours.…”

Child and Adolescent Psychopharmacology

“…Among the more commonly used agents for these children and adolescents, TCAs, stimulants, antihypertensives, and mood stabilizers appear helpful (Connor, 1993;Klorman et a!., 1989;Puig-Antich, 1982;Werry, 1994;Wilens & Biederman, 1992).…”

“…A1though pharmacotherapy is generally not effective in correcting the underlying disorder, medications may reduce aggression and self-injurious or other psychiatric symptoms severely impairing the individual. Beta blockers and clonidine have been increasingly reported to be useful in developmentally disordered patients to control aggression to self and others (Connor, 1993;Kemph, DeVane, Levin,jarecke, & Miller, 1993;Mattes et aI., 1984;Williams, Mehl, Yudofsky, Adams, & Roseman, 1982). Considering the relatively low toxicologic profile of these drugs compared with the antipsychotics, they are the preferred first treatment for the management of these complications (Connor, 1993).…”

“…Beta blockers and clonidine have been increasingly reported to be useful in developmentally disordered patients to control aggression to self and others (Connor, 1993;Kemph, DeVane, Levin,jarecke, & Miller, 1993;Mattes et aI., 1984;Williams, Mehl, Yudofsky, Adams, & Roseman, 1982). Considering the relatively low toxicologic profile of these drugs compared with the antipsychotics, they are the preferred first treatment for the management of these complications (Connor, 1993). Finally, although not adequately investigated in children, beta blockers (propranolol) have been reported to be helpful in adults with ADHD and severe impulsive and dyscontrol symptoms (Ratey et al, 1986;Williams et aI., 1982).…”