Psychopharmacology and Aggression

Psychopharmacologic studies of aggressive behavior in animals under controlled laboratory conditions have been instrumental in developing and evaluating specific and effective novel drug treatments that reduce aggressive behavior. An initial contribution of this research is to create experimental conditions that enable the display of aggressive and defensive acts and postures in species that engage in either dominance or territorial or maternal aggression. Quantitative ethological analyses allow the precise delineation of the sequential organization of aggressive bursts, providing a benchmark for assessing excessive or pathological forms of aggressive behavior. A second contribution of preclinical research is the development of experimental models of escalated forms of aggressive behavior, such as focusing on genetic predispositions or social provocations and frustrative experiences. A critical role of preclinical research is in the pharmacological and neurochemical analysis of aggressive behavior; for example, a host of undesirable side effects prompted a shift from classic dopaminergic neuroleptic compounds to the more recently developed atypical neuroleptics with effective and more specific anti-aggressive effects. The long-established role of brain serotonin in impulsive and escalated forms of aggressive behavior continues to be a focus of preclinical studies. New evidence differentiates dynamic state changes in corticolimbic serotonergic neurons during the termination of aggressive behavior from the deficient-serotonin trait in violence-prone individuals. It can be anticipated that currently developed tools for targeting the genes that code for specific subtypes of serotonin receptors will offer new therapeutic options for reducing aggressive behavior, and the 5-HT(1B) receptor appears to be a promising target. The modulation of GABA and GABA(A) receptors by 5-HT in corticolimbic neurons promises to be particularly relevant for specific forms of escalated aggressive behavior such as alcohol-heightened aggression.

Section: Dopamine and Serotonin: Typical And Atypical Neurolepticsmentioning

confidence: 99%

Escalated Aggressive Behavior: New Pharmacotherapeutic Approaches and Opportunities

Miczek

Faccidomo

Almeida

et al. 2004

“…Given the role of dopamine in mediating reactive aggression in animals, and the clinical association between ADHD and conditions characterized by aggressive behavior (such as ODD, CD, and BPD), the antiaggressive properties of stimulant medications have been studied. In general, studies of children with comorbid ADHD and CD find that such treatment decreases physical and verbal aggression 103–105. As with SRIs, stimulant monotherapy in children with BPD must be approached with caution because of possible activating effects, but the careful use of stimulants combined with mood stabilizers may be appropriate 106.…”

Section: The Neuropharmacology and Treatment Of Irritabilitymentioning

confidence: 99%

Irritability in Pediatric Mania and Other Childhood Psychopathology

Leibenluft

Blair

Charney

et al. 2003

130

Irritability is an important symptom in childhood psychopathology that has received relatively little research attention. Recent controversy concerning the diagnosis of mania in children has focused attention on how little is known about how to assess irritability in a systematic way, and about its diagnostic associations. For example, subtyping irritability according to course (chronic vs. episodic), precipitants, and family history may facilitate the identification of psychopathology and the study of pathophysiology. While normative and pathologic irritability can be differentiated reliably, the validity of the distinction is unclear. In addition, there is a need for scales designed to measure the severity of irritability in children with mood and anxiety disorders. In order to facilitate research, we propose a definition of irritability from the perspective of affective neuroscience. Because reactive aggression may be a helpful animal model for irritability, we review the neural circuitry mediating this behavior. Behavioral paradigms that evoke frustration, as well as those that assess the ability to inhibit a prepotent motor response, maintain attentional focus, execute response reversal, recognize angry faces, and regulate emotional responses, may be useful in the study of irritability. Examples of such paradigms are described, and the pharmacology of irritability is reviewed briefly.

“…Although violence is not a specific criterion for diagnosis, youth with attention‐deficit hyperactivity disorder (ADHD) have high rates of arrests,37 and as many as 30 to 50 percent show comorbidity with conduct disorder (CD),38 of which violence is a common symptom. Stimulant medications have been shown in hundreds of controlled trials to improve academic performance and interpersonal relations in individuals with ADHD, and to diminish the frequency and severity of violent behavior 39…”

Section: Pharmacologic Treatmentmentioning

confidence: 99%

The Psychopharmacologic Treatment of Violent Youth

Gilligan

Lee

2004

Aggressive violence has been described as the greatest problem and the most frequent reason for referrals in child and adolescent psychiatry. In this country we have only partially emerged from an epidemic of violence that was really an epidemic of youth violence. Thus it is hardly surprising that psychiatrists are being asked more and more frequently whether psychiatric medications might help to diminish the toll from this behavioral plague. Medications are useful and appropriate for only a small minority of the people who commit serious violence. Even when they are indicated, they can never be the sole treatment modality, but should be supplemented by psychological and social therapies. When the violence is a byproduct or symptom of an underlying mental illness, treating that illness is generally the most effective method of preventing future violence on a long-term basis. However, most violence is not committed by those who are mentally ill, and most of the mentally ill never commit a serious act of violence. That is why many attempts have been made to discover whether there are drugs that diminish the symptom, violence, even when there is no underlying mental illness for which drugs would normally be prescribed. In fact there are several, and their indications and use are reviewed here. Different principles govern the acute short-term emergency treatment of a violent crisis and the long-term treatment of those who are chronically and repetitively violent, and these differences are also summarized here.