Levetiracetam in Patients With Impulsive Aggression

Mattes, Jeffrey A.

doi:10.4088/jcp.v69n0218

Cited by 39 publications

(50 citation statements)

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“…Recent trials with levetiracetam and oxcarbazepine for impulsive aggression recruited individuals with IED without significant comorbidity (e.g. Mattes, 2005Mattes, , 2008, while other trials recruited subjects with personality disorders and a history of impulsive aggression (e.g. Coccaro et al 2009 ;Hollander et al 2003).…”

Section: Other Personality Disorders Maladaptive Traitsmentioning

confidence: 99%

Evidence-based pharmacotherapy for personality disorders

Ripoll

Triebwasser

Siever

2011

Int. J. Neuropsychopharm.

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Patients with personality disorders are prescribed psychotropic medications with greater frequency than almost any other diagnostic group. Prescribing practices in these populations are often based on anecdotal evidence rather than rigorous data. Although evidence-based psychotherapy remains an integral part of treatment, Axis II psychopathology is increasingly conceptualized according to neurobiological substrates that correspond to specific psychopharmacological strategies. We summarize the best available evidence regarding medication treatment of personality disordered patients and provide optimal strategies for evidence-based practice. Most available evidence is concentrated around borderline and schizotypal personality disorders, with some additional evidence concerning the treatment of avoidant and antisocial personality disorders. Although maladaptive personality symptoms respond to antidepressants, antipsychotics, mood stabilizers, and other medications, evidence-based pharmacotherapy is most useful in treating circumscribed symptom domains and induces only partial improvement. Most available evidence supports use of medication in reducing impulsivity and aggression, characteristic of borderline and antisocial psychopathology. Efforts have also begun to reduce psychotic-like symptoms and improve cognitive deficits characteristic of schizotypy. Indirect evidence is also provided for psychopharmacological reduction of social anxiety central to avoidant personality disorder. Evidence-based practice requires attention to domains of expected clinical improvement associated with a medication, relative to the potential risks. The development of future rational pharmacotherapy will require increased understanding of the neurobiological underpinnings of personality disorders and their component dimensions. Increasing efforts to translate personality theory and social cognitive neuroscience into increasingly specific neurobiological substrates may provide more effective targets for pharmacotherapy.

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Section: Other Personality Disorders Maladaptive Traitsmentioning

confidence: 99%

Evidence-based pharmacotherapy for personality disorders

Ripoll

Triebwasser

Siever

2011

Int. J. Neuropsychopharm.

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“…The subject has three continuous response options: A monetary-reinforced response adds money to the participant's bank after a large fi xed interval, an aggressive response ostensibly removes money from the opponent's bank after a small fi xed interval, and an escape response defends the subject's account from monetary subtractions for a short fi xed interval. Over the course of the study, fi ve doses of tiagabine (4,8,12,16, and 20 mg) were administered to the experimental group in varying order. The 20-mg dose resulted in sedation and numerous side effects, so the data on this dose were not included in the analysis.…”

Section: Tiagabinementioning

confidence: 99%

“…Aggression was quantifi ed using the OAS-M. There was no overall statistical evidence of benefi t from levetiracetam (variable dose, with a maximum of 3000 mg/d) over placebo [16,Class I].…”

Section: Levetiracetammentioning

confidence: 99%

“…It has been suggested that the similar GABA-related mechanisms seen in these AEDs are related to their mood-stabilizing effects [14] and may help explain their effi cacy in treating impulsive aggressive behavior in adults. To date, the only AED that has been studied in a randomized controlled trial and shown not to be effective in treating impulsive aggression is levetiracetam [15,16,Class I]. In addition, the utility of the AEDs in the treatment of impulsive and aggressive behavior in children and adolescents has not been fully determined [9•, Class IV; 17-19, Class I].…”

Section: Introductionmentioning

confidence: 98%

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Pharmacologic treatment of impulsive aggression with antiepileptic drugs

Stanford

Anderson²,

Lake³

et al. 2009

Curr Treat Options Neurol

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Aggressive behavior is a major concern in mental health and criminal justice settings. Although pharmacotherapy is often used in the treatment of the violent individual, no medication is presently approved by the US Food and Drug Administration specifically for such use. In recent years, antiepileptic drugs (AEDs) have become increasingly popular for the management of impulsive (reactive) aggressive behavior. The research literature has implicated several neurobiologic deficits associated with impulsive aggression, including reduced central serotonergic functioning, executive dysfunction, and prefrontal deficits. It has been suggested that the neurobiologic deficits specific to impulsive aggressive behavior may serve as indicators of an ineffective behavioral control system. A review of the literature finds that AEDs, particularly those that block sodium channels and/or have GABA-related mechanisms of action, are effective in reducing the frequency and intensity of impulsive aggressive outbursts both when used as the primary agent of treatment and as an adjunct to ongoing pharmacotherapy. Strong evidence for efficacy in impulsive aggression exists from randomized controlled trials for most of the common AEDs (phenytoin, carbamazepine, oxcarbazepine, lamotrigine, valproate/divalproex sodium, topiramate). Additional controlled studies are needed for tiagabine and gabapentin. Of the common AEDs, only levetiracetam has been shown to be ineffective in the treatment of impulsive aggression. It is important to note that the anti-aggressive effects seen with the AEDs appear to be specific to the impulsive form of aggression. Individuals who display premeditated aggression do not seem to benefit from this type of treatment. Clinically, we recommend phenytoin (initial dose 100 mg three times daily) as the AED of first choice for the treatment of impulsive aggressive outbursts. This recommendation is based on this drug's limited side effect profile (compared with the other AEDs) and the large amount of empiric data supporting its clinical efficacy in impulsive aggression. In the event that the impulsive aggressive individual does not respond to pharmacotherapy with phenytoin, carbamazepine (initial dose 150 mg three times daily) and valproate/divalproex sodium (initial dose 250 mg three times daily) have both proved to be effective secondary options.

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“…We chose treatment with levetiracetam (Keppra ® ) because of the possible double action on epilepsy and on non-epileptic symptoms such as stress, anxiety, and panic; this action has been reported, even if not definitively assessed, by some authors (Farooq et al, 2009;Rugino & Samsock, 2002;Mattes, 2008;Wasserman et al, 2006 …”

Section: Case Reportmentioning

confidence: 99%