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Sicotte R, D'Andrea G, Dumais A, Crocker AG, Villeneuve M, Brochu E, Abdel-Baki A. Aggressive behaviors in first-episode psychosis: Distinction between the premorbid phase and the onset of psychosis. Schizophr Res 2024; 271:283-291. [PMID: 39079405 DOI: 10.1016/j.schres.2024.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 07/12/2024] [Accepted: 07/13/2024] [Indexed: 09/11/2024]
Abstract
BACKGROUND There is a well-established, although complex, association between aggression and psychosis, particularly in the early stages of illness. Some persons display aggressive behaviors even prior to psychosis onset. However, factors associated with aggressive behaviors prior to and at first-episode psychosis (FEP) onset remain underdocumented. AIMS The objective is two-fold: 1) to describe the prevalence of verbal and physical aggression occurring during the premorbid phase and at FEP onset; 2) distinguish the factors associated with aggressive behaviors during these two periods. METHOD Data on aggressive behaviors and factors potentially associated therewith were collected through research interviews and chart reviews among 567 persons with FEP admitted to two early intervention services in Montreal, Canada. Logistic regression analyses were conducted to identify factors associated with aggressive behaviors in both periods. RESULTS In the premorbid phase, 46.1 % (n = 257/558) of patients presented aggression (verbal: 35.9 %; towards objects: 24.2 %; against others: 27.9 %). At FEP, 18.1 % (n = 101/558) presented aggressive behaviors (verbal: 12.9 %; towards objects: 6.1 %; against others: 8.8 %). In the premorbid phase, lower education, prior justice involvement, cluster B personality traits/disorder and poorer functioning were associated with aggressive behaviors, while, at FEP, only prior homelessness was associated with aggression. CONCLUSIONS Aggressive behaviors are frequent in patients with FEP, prior onset and at FEP. Premorbid aggressive behaviors seem to be associated with premorbid difficulties. Early detection of youth with psychosis and those at high risk of psychosis, particularly homeless youth, is necessary to provide access to early specialized interventions and possibly prevent aggressive behaviors and their consequences.
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Affiliation(s)
- Roxanne Sicotte
- Research Center of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada; Department of Psychiatry and Addiction, Université de Montréal, Montréal, Québec, Canada
| | - Giuseppe D'Andrea
- Research Center of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada; Douglas Mental Health University Institute, Prevention and Early Intervention Program for Psychosis (PEPP-Montréal), Montréal, Québec, Canada; Community Mental Health Center of Sassuolo, Department of Mental Health and Drug Abuse, AUSL Modena, Modena, Italy
| | - Alexandre Dumais
- Department of Psychiatry and Addiction, Université de Montréal, Montréal, Québec, Canada; Research Center of the Institut Universitaire en Santé Mentale de Montréal, Montréal, Québec, Canada; Institut National de Psychiatrie Légale Philippe-Pinel Research Center, Montréal, Québec, Canada
| | - Anne G Crocker
- Department of Psychiatry and Addiction, Université de Montréal, Montréal, Québec, Canada; Institut National de Psychiatrie Légale Philippe-Pinel Research Center, Montréal, Québec, Canada; School of Criminology, Université de Montréal, Montréal, Québec, Canada
| | - Marie Villeneuve
- Department of Psychiatry and Addiction, Université de Montréal, Montréal, Québec, Canada
| | - Edouard Brochu
- Department of Psychiatry and Addiction, Université de Montréal, Montréal, Québec, Canada
| | - Amal Abdel-Baki
- Research Center of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada; Department of Psychiatry and Addiction, Université de Montréal, Montréal, Québec, Canada.
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Choy O. Nutritional factors associated with aggression. Front Psychiatry 2023; 14:1176061. [PMID: 37415691 PMCID: PMC10320003 DOI: 10.3389/fpsyt.2023.1176061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/16/2023] [Indexed: 07/08/2023] Open
Abstract
Although the vast majority of patients in forensic psychiatry are treated using pharmacological agents, clinical and ethical concerns about their use have led to the consideration of alternative strategies to reduce aggression that is common in forensic psychiatric settings. One non-invasive and benign biologically-based treatment approach involves nutrition. This article provides a mini-review of the recent evidence on four salient nutritional factors associated with aggressive behavior, namely omega-3 fatty acids, vitamin D, magnesium, and zinc. The current evidence base indicates that lower omega-3 levels are associated with increased aggression. Although research on vitamin D and zinc in relation to aggressive behavior is more limited, there is initial evidence that they are negatively associated with aggression in healthy participants and in psychiatric samples. The relationship between magnesium and aggression varies depending on how magnesium is assessed. Findings from experimental trials reveal that nutritional intervention in the form of omega-3 supplementation has the potential to serve as an effective mode of treatment, with effects that can last beyond the intervention period. There is also support for the utility of nutrition to improve our understanding of how social processes are linked to aggression. In light of the nascent, but promising findings on the role of nutritional factors on aggressive behavior, directions for future research are discussed.
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Fico G, Janiri D, Pinna M, Sagué-Vilavella M, Gimenez Palomo A, Oliva V, De Prisco M, Cortez PG, Anmella G, Gonda X, Sani G, Tondo L, Vieta E, Murru A. Affective temperaments mediate aggressive dimensions in bipolar disorders: A cluster analysis from a large, cross-sectional, international study. J Affect Disord 2023; 323:327-335. [PMID: 36470551 DOI: 10.1016/j.jad.2022.11.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/22/2022] [Accepted: 11/25/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Affective temperaments show potential for aggressive behavior (AB) preventive strategies in bipolar disorder (BD). We aim to define intra-diagnostic subgroups of patients with BD based on homogeneous behaviors related to AB. Subsequently, to assess whether affective temperament dimensions may contribute to the presence and severity of AB. METHODS Patients with BD were recruited. AB was evaluated through the modified overt aggression scale (MOAS); affective temperaments were assessed with the TEMPS-A. A cluster analysis was conducted based on TEMPS-A and MOAS scores. Stepwise backward logistic regression models were used to identify the predictive factors of cluster membership. RESULTS 799 patients with BD were enrolled. Three clusters were determined: non-aggressive (55.5 %), self-aggressive (18 %), and hetero-aggressive (26.5 %). Depressive, irritable, and anxious temperament scores significantly increased from the non-aggressive (lower) to the self-aggressive (intermediate) and the hetero-aggressive group (highest). A positive history of a suicide attempt (B = 5.131; OR = 169.2, 95 % CI 75.9; 377) and rapid cycling (B = -0.97; OR = 0.40, 95 % CI 0.17; 0.95) predicted self-aggressive cluster membership. Atypical antipsychotics (B = 1.19; OR = 3.28, 95 % CI 2.13; 5.06) or SNRI treatment (B = 1.09; OR = 3, 95 % CI 1.57; 5.71), psychotic symptoms (B = 0.73; OR = 2.09, 95 % CI 1.34; 3.26), and history of a suicide attempt (B = -1.56; OR = 0.20, 95 % CI 0.11; 0.38) predicted hetero-aggressive cluster membership. LIMITATIONS Recall bias might have affected the recollection of AB. CONCLUSIONS Clinical factors orientate the prevention of different ABs in BD. Affective temperaments might play a role in preventing AB since patients with more pronounced affective temperaments might have an increased risk of showing AB, in particular hetero-AB.
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Affiliation(s)
- Giovanna Fico
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036 Barcelona, Spain; Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, c. Villarroel, 170, 08036 Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036 Barcelona, Spain; Institute of Neurosciences (UBNeuro), p. de la Vall d'Hebron, 171, 08035 Barcelona, Spain
| | - Delfina Janiri
- Department of Neuroscience, Section of Psychiatry, Catholic University of the Sacred Hearth, Roma, Italy; Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Marco Pinna
- Lucio Bini Mood Disorders Center, Cagliari, Italy; Section of Psychiatry, Department of Medical Science and Public Health, University of Cagliari, Italy
| | - Maria Sagué-Vilavella
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036 Barcelona, Spain; Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, c. Villarroel, 170, 08036 Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036 Barcelona, Spain; Institute of Neurosciences (UBNeuro), p. de la Vall d'Hebron, 171, 08035 Barcelona, Spain
| | - Anna Gimenez Palomo
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036 Barcelona, Spain; Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, c. Villarroel, 170, 08036 Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036 Barcelona, Spain; Institute of Neurosciences (UBNeuro), p. de la Vall d'Hebron, 171, 08035 Barcelona, Spain
| | - Vincenzo Oliva
- Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, c. Villarroel, 170, 08036 Barcelona, Spain; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Michele De Prisco
- Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, c. Villarroel, 170, 08036 Barcelona, Spain; CIBER de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Section of Psychiatry, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University of Naples, Naples, Italy
| | - Pablo Guzmán Cortez
- Institut Clínic de Neurociències, Psychiatry and Psychology Service, Grup Recerca Addiccions Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Gerard Anmella
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036 Barcelona, Spain; Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, c. Villarroel, 170, 08036 Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036 Barcelona, Spain; Institute of Neurosciences (UBNeuro), p. de la Vall d'Hebron, 171, 08035 Barcelona, Spain
| | - Xenia Gonda
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary; NAP-2-SE New Antidepressant Target Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary; International Centre for Education and Research in Neuropsychiatry, Samara State Medical University, Russia
| | - Gabriele Sani
- Department of Neuroscience, Section of Psychiatry, Catholic University of the Sacred Hearth, Roma, Italy; Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Leonardo Tondo
- Lucio Bini Mood Disorders Center, Cagliari, Italy; Section of Psychiatry, Department of Medical Science and Public Health, University of Cagliari, Italy; McLean Hospital-Harvard Medical School, Boston, USA
| | - Eduard Vieta
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036 Barcelona, Spain; Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, c. Villarroel, 170, 08036 Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036 Barcelona, Spain; Institute of Neurosciences (UBNeuro), p. de la Vall d'Hebron, 171, 08035 Barcelona, Spain; CIBER de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.
| | - Andrea Murru
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036 Barcelona, Spain; Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, c. Villarroel, 170, 08036 Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036 Barcelona, Spain; Institute of Neurosciences (UBNeuro), p. de la Vall d'Hebron, 171, 08035 Barcelona, Spain; CIBER de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
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Herttua K, Crawford M, Paljarvi T, Fazel S. Associations between antipsychotics and risk of violent crimes and suicidal behaviour in personality disorder. EVIDENCE-BASED MENTAL HEALTH 2022; 25:e58-e64. [PMID: 36283800 PMCID: PMC9811101 DOI: 10.1136/ebmental-2022-300493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 09/29/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Despite uncertain benefits, people with personality disorder are commonly treated with antipsychotic medication. OBJECTIVE To investigate the association between antipsychotics and violent crimes and suicidal behaviour in individuals with personality disorder. METHODS We used nationwide Danish registries to identify all individuals with diagnosed personality disorder aged 18-64 years during 2007 to 2016. Antipsychotics were recorded in dispensed prescriptions, and individuals were followed up for police-recorded suspicions for violent crimes and healthcare presentations of suicidal behaviour. We applied a within-individual design where outcome rates for individuals with personality disorder during medicated periods were compared with rates during non-medicated periods. FINDINGS The cohort included 166 328 people with diagnosed personality disorder, of whom 79 253 were prescribed antipsychotics, presented at least one outcome and were thus included in the within-individual analyses. Compared with periods when individuals were not on antipsychotic medication, violent crime suspicions were 40% lower (incident rate ratio (IRR) 0.60, 95% CI 0.55 to 0.63) in men and 10% lower (IRR 0.90, 95% CI 0.79 to 1.01) in women, while rates of suicidal behaviour were 32% lower both in men (IRR 0.68, 95% CI 0.66 to 0.71) and in women (IRR 0.68, 95% CI 0.65 to 0.70). In subgroup analyses, the magnitude of the association varied across specific personality disorders for criminal outcomes but less for suicidal behaviour, with largest association in dissocial personality disorder for violent criminality (IRR 0.53, 95% CI 0.47 to 0.59). CONCLUSIONS Treatment with antipsychotics was associated with reduced risks for violent crime suspicions and suicidal behaviour among individuals with personality disorder. CLINICAL IMPLICATIONS Potential effects of antipsychotics on suicidal behaviour and violence should be taken into account when considering treatment options for people with personality disorders.
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Affiliation(s)
- Kimmo Herttua
- Public Health, University of Southern Denmark - Campus Esbjerg, Esbjerg, Denmark
| | - Mike Crawford
- Department of Brain Sciences, Imperial College London Faculty of Medicine, London, UK
| | - Tapio Paljarvi
- Psychiatry, Oxford University, Oxford, UK
- Psychiatry, Niuvanniemi Hospital, Kuopio, Finland
| | - Seena Fazel
- Psychiatry, University of Oxford, Oxford, UK
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Mauri MC, Cirnigliaro G, Piccoli E, Vismara M, De Carlo V, Girone N, Dell’Osso B. Substance Abuse Associated with Aggressive/Violent Behaviors in Psychiatric Outpatients and Related Psychotropic Prescription. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00842-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
AbstractPsychiatric
disorders with substance abuse are considered the leading causes of most violent and aggressive behaviors in the general population. This study was aimed to assess the impact of substance abuse and the therapeutic approaches adopted by psychiatrists in aggressive vs non-aggressive outpatients (n = 400) attending community-based psychiatric services and recruited over a 3-year period. Clinical and therapeutic variables were collected from medical records and the Modified Overt Aggression Scale (MOAS) was used to assess any aggressive/violent behavior. Violent behaviors were significantly higher in alcohol and substance abusers compared to non-abusers (p < 0.01), except for heroin abusers. Mean weighted MOAS score was significantly higher in patients taking antipsychotics (p < 0.005). The administration of Haloperidol, Zuclopenthixol, and Clozapine was more frequent in aggressive than in non-aggressive patients. The most frequently administered drug in these patients was Haloperidol (23.91%), with a higher mean daily dosage in violent vs non-violent patients. Our results confirm the well-established relationship between substance abuse and violent behaviors in psychiatric inpatients also within outpatient community services. Observed rates of most frequently prescribed antipsychotics to aggressive patients did not show any preference for newer generation compounds, with clinicians operating in the community setting likely being in need for further evidence and specific training to support their treatment choice.
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Hindley G, Bahrami S, Steen NE, O'Connell KS, Frei O, Shadrin A, Bettella F, Rødevand L, Fan CC, Dale AM, Djurovic S, Smeland OB, Andreassen OA. Characterising the shared genetic determinants of bipolar disorder, schizophrenia and risk-taking. Transl Psychiatry 2021; 11:466. [PMID: 34497263 PMCID: PMC8426401 DOI: 10.1038/s41398-021-01576-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 07/19/2021] [Accepted: 08/18/2021] [Indexed: 02/08/2023] Open
Abstract
Increased risk-taking is a central component of bipolar disorder (BIP) and is implicated in schizophrenia (SCZ). Risky behaviours, including smoking and alcohol use, are overrepresented in both disorders and associated with poor health outcomes. Positive genetic correlations are reported but an improved understanding of the shared genetic architecture between risk phenotypes and psychiatric disorders may provide insights into underlying neurobiological mechanisms. We aimed to characterise the genetic overlap between risk phenotypes and SCZ, and BIP by estimating the total number of shared variants using the bivariate causal mixture model and identifying shared genomic loci using the conjunctional false discovery rate method. Summary statistics from genome wide association studies of SCZ, BIP, risk-taking and risky behaviours were acquired (n = 82,315-466,751). Genomic loci were functionally annotated using FUMA. Of 8.6-8.7 K variants predicted to influence BIP, 6.6 K and 7.4 K were predicted to influence risk-taking and risky behaviours, respectively. Similarly, of 10.2-10.3 K variants influencing SCZ, 9.6 and 8.8 K were predicted to influence risk-taking and risky behaviours, respectively. We identified 192 loci jointly associated with SCZ and risk phenotypes and 206 associated with BIP and risk phenotypes, of which 68 were common to both risk-taking and risky behaviours and 124 were novel to SCZ or BIP. Functional annotation implicated differential expression in multiple cortical and sub-cortical regions. In conclusion, we report extensive polygenic overlap between risk phenotypes and BIP and SCZ, identify specific loci contributing to this shared risk and highlight biologically plausible mechanisms that may underlie risk-taking in severe psychiatric disorders.
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Affiliation(s)
- Guy Hindley
- NORMENT, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407, Oslo, Norway.
- Psychosis Studies, Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK.
| | - Shahram Bahrami
- NORMENT, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407, Oslo, Norway
| | - Nils Eiel Steen
- NORMENT, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407, Oslo, Norway
| | - Kevin S O'Connell
- NORMENT, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407, Oslo, Norway
| | - Oleksandr Frei
- NORMENT, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407, Oslo, Norway
- Center for Bioinformatics, Department of Informatics, University of Oslo, Blindern, 0316, Oslo, Norway
| | - Alexey Shadrin
- NORMENT, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407, Oslo, Norway
| | - Francesco Bettella
- NORMENT, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407, Oslo, Norway
| | - Linn Rødevand
- NORMENT, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407, Oslo, Norway
| | - Chun C Fan
- Department of Neurology, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
- Multimodal Imaging Laboratory, University of California San Diego, La Jolla, CA, 92093, USA
| | - Anders M Dale
- Department of Neurology, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
- Department of Radiology, University of California, San Diego, La Jolla, CA, 92093, USA
- Department of Cognitive Science, University of California, San Diego, La Jolla, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Srdjan Djurovic
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
- NORMENT, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Olav B Smeland
- NORMENT, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407, Oslo, Norway
| | - Ole A Andreassen
- NORMENT, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407, Oslo, Norway.
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Sharma A, McClellan J. Emotional and Behavioral Dysregulation in Severe Mental Illness. Child Adolesc Psychiatr Clin N Am 2021; 30:415-429. [PMID: 33743948 DOI: 10.1016/j.chc.2020.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Emotional and behavioral dysregulation are common in severe mental illnesses, including schizophrenia, bipolar disorder, and borderline personality disorder. Emotional instability and behavioral outbursts can be driven by internal processes and/or environmental triggers and interpersonal interactions. Understanding the underlying diagnosis is important in determining the best course of treatment. Disorder-specific treatments are important in addressing underlying drivers of emotional dysregulation, irritability, and aggression. Coping skills training and behavioral modification strategies have broad applicability and are useful for aggression and irritability. Treatment planning to address emotion dysregulation and aggression in severe mental illness should address psychiatric comorbidities, substance use, and medication adherence.
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Affiliation(s)
- Aditi Sharma
- Department of Psychiatry and Behavioral Sciences, University of Washington, 4800 Sand Point WAY Northeast, MS OA.5.154, Seattle, WA 98105, USA
| | - Jon McClellan
- Department of Psychiatry and Behavioral Sciences, University of Washington, 8805 Steilacoom Boulevard Southwest, Lakewood, WA 98498, USA.
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Chou D. Topiramate inhibits offensive aggression through targeting ventrolateral periaqueductal gray. Neuropharmacology 2020; 181:108361. [PMID: 33096107 DOI: 10.1016/j.neuropharm.2020.108361] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/06/2020] [Accepted: 10/16/2020] [Indexed: 01/07/2023]
Abstract
Topiramate is an approved antiepileptic drug clinically used to treat epilepsy and prevent migraines. Currently, topiramate has been found to be effective in treating aggressive symptoms in neuropsychiatric patients. In preclinical studies, however, the effects and mechanisms of topiramate on offensive aggression are still largely uninvestigated. Our previous studies indicated that glutamatergic transmission in the ventrolateral periaqueductal gray (vlPAG) plays a crucial role in regulating elements of offensive aggressive behaviors. In the present work, we investigated the actions of topiramate on vlPAG glutamatergic transmission and aggressive behaviors in group-housed (GH) and socially isolated (SI) rats. The results suggested that a single injection of topiramate systemically and dose-dependently inhibited elements of offensive aggressive behaviors of both GH and SI rats in the resident-intruder test (RIT), with long-lasting effective time profiles in SI rats. Moreover, systemic single administration of topiramate reduced the frequency and amplitude of miniature excitatory postsynaptic currents (mEPSCs) in the vlPAG. Bath perfusion of topiramate directly decreased the frequency and amplitude of mEPSCs and shortened the amplitude of evoked excitatory postsynaptic currents (EPSCs) in the vlPAG. Furthermore, intra-vlPAG single microinjection of topiramate dose-dependently inhibited offensive aggressive behaviors in GH and SI rats in a time-dependent manner. Additionally, both systemic and local topiramate inhibited offensive aggressive behaviors in a (2R,6R)-hydroxynorketamine (HNK)-dependent rat model. In conclusion, the present results suggest that topiramate exerts anti-aggressive roles through its inhibitory actions on glutamatergic activities in the vlPAG. These preclinical results support topiramate as a candidate drug to treat patients with heightened offensive aggression.
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Affiliation(s)
- Dylan Chou
- Department of Physiology, Zhuhai Campus of Zunyi Medical University, Zhuhai, Guangdong, China.
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Johnson SL, Zisser MR, Sandel DB, Swerdlow BA, Carver CS, Sanchez AH, Fernandez E. Development of a brief online intervention to address aggression in the context of emotion-related impulsivity: Evidence from a wait-list controlled trial. Behav Res Ther 2020; 134:103708. [PMID: 32896743 DOI: 10.1016/j.brat.2020.103708] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 08/01/2020] [Accepted: 08/04/2020] [Indexed: 11/15/2022]
Abstract
Trait-like tendencies to respond impulsively to emotion, labelled emotion-related impulsivity, are robustly related to aggression. We developed and tested an online intervention to address emotion-related impulsivity and aggression. The 6-session intervention focused on behavioral techniques shown to decrease arousal and aggression, supplemented with implementation intentions and smartphone prompts to facilitate skills transfer into daily life. First, we piloted the intervention in-person with 4 people. Then, 235 participants were randomly assigned to take the online intervention immediately or after a wait-list period; those in the waitlist were then invited to take part in the intervention. Participants completed the self-rated Feelings Trigger Action Scale to assess emotion-related impulsivity, the interview-based Modified Overt Aggression Scale and the self-rated Buss Perry Aggression Questionnaire. Participants who took part in the treatment completed daily anger logs. Attrition, as with other online programs, was high; however, treatment completers reported high satisfaction, and outcomes changed more rapidly during treatment than waitlist across all key outcome indices. In analyses including all participants who took part in the treatment (immediate or delayed), we observed moderate-to-large treatment gains, which were maintained as of the 3-month follow-up assessment. This work supports the usefulness of an intervention for addressing emotion-related impulsivity and aggression.
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10
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Bouchatta O, Chaibi I, Baba AA, Ba-M'Hamed S, Bennis M. The effects of Topiramate on isolation-induced aggression: a behavioral and immunohistochemical study in mice. Psychopharmacology (Berl) 2020; 237:2451-2467. [PMID: 32430516 DOI: 10.1007/s00213-020-05546-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 05/05/2020] [Indexed: 10/24/2022]
Abstract
Topiramate, an antiepileptic drug, has been found to be useful for the treatment of aggression in clinical populations. Most preclinical studies related to Topiramate have been focused exclusively on the quantitative aspects of the aggressive behavior between mice. However, there is still limited knowledge regarding the effects of Topiramate on neuronal mechanisms occurring in aggressive mice. The present work aims to understand further the effects of the antiepileptic drug Topiramate on aggressive behaviors, and on the neural correlates underlying such behaviors. To achieve this, we combined the resident-intruder model of isolation-induced aggression in mice with two drug regimens of Topiramate administration (30.0 mg/kg; acute and sub-chronic treatments). Our data showed that both acute and subchronic treatments decreased the intensity of agonistic encounters and reinforced social behavior. By using C-fos immunoreactivity, we investigated the neuronal activation of several brain regions involved in aggressive behavior following subchronic treatment. We found that Topiramate produced activation in several cortical areas and in the lateral septum of resident brain mice compared with their controls. However, Topiramate induced inhibition in the medial nucleus of the amygdala, the dorsomedial nucleus of the periaqueductal gray, and especially in the anterior hypothalamic nucleus. Finally, we performed microinfusion of Topiramate (0.1 and 0.3 mM) into the lateral septum and anterior hypothalamus on offensive behaviors in isolation-induced-aggression paradigm. Interestingly, the microinfusion of Topiramate into the lateral septum has the capacity to alleviate aggressive behavior, without affecting social behavior. However, the microinfusion of Topiramate into the anterior hypothalamus decreased aggressive behavior and slightly reinforced social behavior. Our observations supported that the dose of 0.1 mM of Topiramate appeared more efficacy to treat aggression in adult mice. These pharmacological characteristics may account for Topiramate efficacy on aggressive symptoms in psychiatric patients.
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Affiliation(s)
- Otmane Bouchatta
- Laboratory of Pharmacology, Neurobiology and Behavior, Faculty of Sciences Semlalia, Cadi Ayyad University, Bd. Prince My Abdallah, 40000, Marrakesh, Morocco
| | - Ilias Chaibi
- Laboratory of Pharmacology, Neurobiology and Behavior, Faculty of Sciences Semlalia, Cadi Ayyad University, Bd. Prince My Abdallah, 40000, Marrakesh, Morocco
| | - Abdelfatah Ait Baba
- Laboratory of Pharmacology, Neurobiology and Behavior, Faculty of Sciences Semlalia, Cadi Ayyad University, Bd. Prince My Abdallah, 40000, Marrakesh, Morocco
| | - Saadia Ba-M'Hamed
- Laboratory of Pharmacology, Neurobiology and Behavior, Faculty of Sciences Semlalia, Cadi Ayyad University, Bd. Prince My Abdallah, 40000, Marrakesh, Morocco
| | - Mohamed Bennis
- Laboratory of Pharmacology, Neurobiology and Behavior, Faculty of Sciences Semlalia, Cadi Ayyad University, Bd. Prince My Abdallah, 40000, Marrakesh, Morocco.
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11
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Mady N, Linnaranta O, Demchenko I, Carboni-Jiménez A, Maduro A, Tounkara F, Sapkota RP, Brunet A. Actigraphic patterns, impulsivity, and mood instability in bipolar disorder, borderline personality disorder, and healthy controls. Acta Psychiatr Scand 2020; 142:154-155. [PMID: 32623718 DOI: 10.1111/acps.13207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/19/2020] [Accepted: 06/25/2020] [Indexed: 11/28/2022]
Affiliation(s)
- N Mady
- Psychiatry, McGill University Faculty of Medicine, Montreal, QC, Canada
| | - O Linnaranta
- Psychiatry, McGill University Faculty of Medicine, Montreal, QC, Canada
| | - I Demchenko
- Integrated Program in Neuroscience, McGill University, Montreal, QC, Canada
| | - A Carboni-Jiménez
- Psychiatry, McGill University Faculty of Medicine, Montreal, QC, Canada
| | - A Maduro
- Psychiatry, McGill University Faculty of Medicine, Montreal, QC, Canada
| | - F Tounkara
- Integrated Program in Neuroscience, McGill University, Montreal, QC, Canada
| | - R P Sapkota
- Psychiatry, McGill University Faculty of Medicine, Montreal, QC, Canada
| | - A Brunet
- Psychiatry, McGill University Faculty of Medicine, Montreal, QC, Canada.,Psychosocial Division, Douglas Mental Health University Institute, Montreal, QC, Canada
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12
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Einberger C, Puckett A, Ricci L, Melloni R. Contemporary Pharmacotherapeutics and the Management of Aggressive Behavior in an Adolescent Animal Model of Maladaptive Aggression. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2020; 18:188-202. [PMID: 32329300 PMCID: PMC7236798 DOI: 10.9758/cpn.2020.18.2.188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/02/2019] [Accepted: 09/21/2019] [Indexed: 12/28/2022]
Abstract
Objective Antipsychotic and anticonvulsant medications are increasingly being used as pharmacotherapeutic treatments for maladaptive aggression in youth, yet no information is available regarding whether these drugs exhibit aggression- specific suppression in preclinical studies employing adolescent animal models of maladaptive aggression. This study examined whether the commonly used antipsychotics medications haloperidol and risperidone and the anticonvulsant medication valproate exert selective aggression-suppressing effects using a validated adolescent animal model of maladaptive aggression. Methods Twenty-seven-day old Syrian hamsters (Mesocricetus auratus) were administered testosterone for 30 consecutive days during the first 4 weeks of adolescent development. The following day (during late adolescence), experimental animals received a single dose of haloperidol (0.00, 0.025, 0.50, 1.0 mg/kg), risperidone (0.00, 0.01, 0.03, 1.0 mg/kg), or valproate (0.00, 1.0, 5.0, 10.0 mg/kg) and tested for offensive aggression using the Resident/Intruder Paradigm. As a baseline, non-aggressive behavioral control, a separate set of pubertal hamsters was treated with sesame oil vehicle during the first 4 weeks of adolescence and then tested for aggression during late adolescence in parallel with the haloperidol, risperidone or valproate-treated experimental animals. Results Risperidone and valproate selectively reduced the highly impulsive and intense maladaptive aggressive phenotype in a dose-dependent fashion. While haloperidol marginally reduced aggressive responding, its effects were non-specific as the decrease in aggression was concurrent with reductions in a several ancillary (non-aggressive) behaviors. Conclusion These studies provide pre-clinical evidence that the contemporary pharmacotherapeutics risperidone and valproate exert specific aggression-suppressing effects in an adolescent animal model of maladaptive aggression.
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Affiliation(s)
- Clare Einberger
- Department of Psychology, Northeastern University, Boston, MA, USA
| | - Amanda Puckett
- Department of Psychology, Northeastern University, Boston, MA, USA
| | - Lesley Ricci
- Department of Psychology, Northeastern University, Boston, MA, USA
| | - Richard Melloni
- Department of Psychology, Northeastern University, Boston, MA, USA.,Program in Behavioral Neuroscience, Northeastern University, Boston, MA, USA
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13
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Johnson SL, Sandel DB, Zisser M, Pearlstein JG, Swerdlow BA, Sanchez AH, Fernandez E, Carver CS. A brief online intervention to address aggression in the context of emotion-related impulsivity for those treated for bipolar disorder: Feasibility, acceptability and pilot outcome data. JOURNAL OF BEHAVIORAL AND COGNITIVE THERAPY 2020; 30:65-74. [PMID: 34113851 DOI: 10.1016/j.jbct.2020.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Although aggression is related to manic symptoms among those with bipolar disorder, new work suggests that some continue to experience elevations of aggression after remission. This aggression post-remission appears related to a more general tendency to respond impulsively to states of emotion, labelled emotion-related impulsivity. We recently developed the first intervention designed to address aggression in the context of emotion-related impulsivity. Here, we describe feasibility, acceptability, and pilot data on outcomes for 21 persons who received treatment for bipolar disorder and endorsed high levels of aggression and emotion-related impulsivity. As with other interventions for aggression or bipolar disorder, attrition levels were high. Those who completed the intervention showed large changes in aggression using the interview-based Modified Overt Aggression Scale that were sustained through three months and not observed during wait list control. Although they also showed declines in the self-rated Buss-Perry Aggression Questionnaire and in self-rated emotion-related impulsivity as assessed with the Feelings Trigger Action Scale, these self-ratings also declined during the waitlist control. t Despite the limitations, the findings provide the first evidence that a brief, easily disseminated intervention could have promise for reducing aggression among those with bipolar disorder.
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Affiliation(s)
- Sheri L Johnson
- University of California Berkeley, Mail Code 2010, Berkeley Way West Room 3302, 2121 Berkeley Way, 94720-2010 Berkeley, CA, United States
| | - Devon B Sandel
- University of California Berkeley, Mail Code 2010, Berkeley Way West Room 3302, 2121 Berkeley Way, 94720-2010 Berkeley, CA, United States
| | - Mackenzie Zisser
- University of California Berkeley, Mail Code 2010, Berkeley Way West Room 3302, 2121 Berkeley Way, 94720-2010 Berkeley, CA, United States
| | - Jennifer G Pearlstein
- University of California Berkeley, Mail Code 2010, Berkeley Way West Room 3302, 2121 Berkeley Way, 94720-2010 Berkeley, CA, United States
| | - Benjamin A Swerdlow
- University of California Berkeley, Mail Code 2010, Berkeley Way West Room 3302, 2121 Berkeley Way, 94720-2010 Berkeley, CA, United States
| | - Amy H Sanchez
- University of California Berkeley, Mail Code 2010, Berkeley Way West Room 3302, 2121 Berkeley Way, 94720-2010 Berkeley, CA, United States
| | - Ephrem Fernandez
- University of Texas San Antonio, San Antonio, Texas, United States
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14
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Robb AS, Schwabe S, Ceresoli-Borroni G, Nasser A, Yu C, Marcus R, Candler SA, Findling RL. A proposed anti-maladaptive aggression agent classification: improving our approach to treating impulsive aggression. Postgrad Med 2019; 131:129-137. [PMID: 30678534 DOI: 10.1080/00325481.2019.1574401] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Proper drug categorization enables clinicians to readily identify the agents most appropriate for patients in need. Currently, patients with maladaptive aggression do not all always fall into a single existing diagnostic or treatment category. Such is the case for those with impulsive aggression (IA). IA is an associated feature of numerous neuropsychiatric disorders, and can be described as eruptive, aggressive behavior or a 'short fuse'. Although agents from a broad spectrum of drug classes have been used to treat maladaptive aggression, few have been tested distinctly in patients with IA, and there is no drug specifically indicated by the US Food and Drug Administration (US FDA) for IA. Further, current treatments often fail to sufficiently treat IA symptomatology. These issues create an unclear and inadequate treatment path for patients. Here we will propose the establishment of a class of anti-maladaptive aggression agents to begin addressing this clinical issue. The development of such a class would unify the various drugs currently used to treat maladaptive aggression and streamline the treatment approach towards IA. As an important case example of the range of candidate drugs that could fit into a new anti-maladaptive aggression agent category, we will review an investigational IA pharmacotherapy. SPN-810 (extended-release molindone) is currently being investigated as a novel treatment for children with IA and ADHD. Based on these studies we will review how SPN-810 may be well suited for a new, anti-maladaptive aggression drug class and more precisely, a proposed subgroup of IA modulators. The goal of this review is to begin improving the identification of and therapeutic approach for maladaptive aggression as well as IA through more precise anti-maladaptive aggression agent categorization.
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Affiliation(s)
- Adelaide S Robb
- a Psychology and Behavioral Health , Children's National Medical Center , Washington , DC , USA
| | - Stefan Schwabe
- b Research & Development , Supernus Pharmaceuticals, Inc. , Rockville , MD , USA
| | | | - Azmi Nasser
- c Clinical Research , Supernus Pharmaceuticals, Inc. , Rockville , MD , USA
| | - Chungping Yu
- d Preclinical DMPK and Pharmacology , Supernus Pharmaceuticals, Inc. , Rockville , MD , USA
| | - Ronald Marcus
- c Clinical Research , Supernus Pharmaceuticals, Inc. , Rockville , MD , USA
| | - Shawn A Candler
- e Medical Affairs , Supernus Pharmaceuticals, Inc. , Rockville , MD , USA
| | - Robert L Findling
- f Psychiatry and Behavioral Sciences , Johns Hopkins University , Baltimore , MD , USA.,g Psychiatric Services and Research , Kennedy Krieger Institute , Baltimore , MD , USA
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15
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Na +, K +-ATPase inhibition causes hyperactivity and impulsivity in mice via dopamine D2 receptor-mediated mechanism. Neurosci Res 2018; 146:54-64. [PMID: 30296459 DOI: 10.1016/j.neures.2018.10.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 09/28/2018] [Accepted: 10/02/2018] [Indexed: 11/20/2022]
Abstract
Hyperactivity and impulsivity are common symptoms in several psychiatric disorders. Although dysfunction of Na+, K+-ATPase has been reported to be associated with the psychiatric disorders, it is not clear whether inhibition of Na+, K+-ATPase causes behavioral effects, including hyperactivity and impulsivity, in mice. Here, we evaluated the effect of intracerebroventricular (icv) injection of ouabain, an inhibitor of Na+, K+-ATPase, on hyperactivity and impulsivity in mice. At seven days after icv injection, ouabain-injected mice displayed the increase in the distance traveled in the open field arena in the open field test and the increase in the number of head-dipping behavior in the cliff avoidance test. Chlorpromazine or haloperidol, typical antipsychotics, reduced the hyperactivity and impulsivity in ouabain-injected mice. On the other hand, neither lithium carbonate nor valproate, established mood-stabilizing drugs, improved hyperactivity and impulsivity in our mouse model. Furthermore, ouabain-injected mice exhibited the increase in the number of c-fos-positive cells in the nucleus accumbens and the prefrontal cortex but not in the ventral tegmental area, which was reduced by haloperidol. These results suggest that the dysfunction of Na+, K+-ATPase causes hyperactivity and impulsivity via hyperactivation of dopamine D2 receptor-mediated signaling pathway, causing disturbed neuronal circuits in mice.
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