The Pharmacotherapy of Human Aggression: A Review

Aggression is a common treatment problem that may be associated with several disorders including schizophrenia, schizoaffective disorder, acute mania/bipolar disorder, personality disorders, substance abuse disorders, medical disorders, neurological disorders, and medication misadventures. Aggression is not a linear entity, it is a multidimensional problem influenced by a patient's environment and biological, psychological, and/or neurological status. It follows that if one has a multidimensional treatment problem, then a compre hensive treatment plan must be used to achieve optimal management. The comprehensive treatment of aggression should include a thorough baseline evaluation, regular objective measurement of aggression severity using a rating scale (eg, Overt Aggression Scale), psychological interventions, behavioral interventions, pharmacotherapy and, if necessary, seclusion and/or restraint. The pharmacotherapy of aggres sion includes the traditional antipsychotics and benzodiazepines, which are most commonly used; other pharmacotherapies frequently selected include the β-blockers, carbamazepine, and lithium. Despite these pharmacotherapeutic options and despite a pharmacological rationale for each one, the medications used for the treatment of aggression are at least in part nonspecific for aggression. The nonspecificity of these pharmacotherapies is best exemplified by the common use of multiple drug regimens. This may then lead to drug misadventures either in the form of drug-drug interactions, adverse effects, or toxicity. The serenics are a class of phenylpiperazine compounds that have exhibited some promise as being more selective anti- aggression drugs. Eltoprazine, the first member of this new class, is in early phases of human investigation. Copyright © 1996 by W.B. Saunders Company

GABAergic function in Alzheimer's disease: evidence for dysfunction and potential as a therapeutic target for the treatment of behavioural and psychological symptoms of dementia

Alzheimer's disease (AD) is characterized by disruptions in multiple major neurotransmitters. While many studies have attempted to establish whether GABA is disrupted in AD patients, findings have varied. We review evidence for disruptions in GABA among patients with AD and suggest that the variable findings reflect subtypes of the disease that are possibly manifested clinically by differing behavioural symptoms. GABA, the major inhibitory neurotransmitter, has long been a target for anxiolytics, hypnotic sedatives, and anticonvulsants. We review the clinical use of GABAergic agents in treating persons with AD symptoms. While newer generation GABAergic medications are now available, they have yet to be evaluated among patients with AD.

Explosive outbursts in children with Tourette's disorder

OBJECTIVE

Sudden, explosive outbursts of behavior occur in some children with Tourette's disorder (TD). The etiology of these symptoms is unknown. This study investigated the relationship between explosive outbursts, TD, and its comorbid disorders.

METHOD

Tic type and severity and the presence of specific comorbid disorders were compared in 37 children with TD and explosive outbursts and 31 children with TD who did not have such symptoms.

RESULTS

Children with TD and explosive outbursts were more likely to demonstrate significant comorbid conditions, particularly attention-deficit/hyperactivity disorder, obsessive-compulsive disorder, and oppositional defiant disorder. Tic type and severity did not appear related to the presence of explosive outbursts. A highly significant relationship was demonstrated between the number of comorbid psychiatric diagnoses and explosive outbursts.

CONCLUSIONS

Explosive outbursts in children with TD resemble intermittent explosive disorder and may reflect dysregulation of diverse domains of brain function. The presence of such symptoms should alert the clinician to underlying comorbid conditions.

Physiologic characterization of novel aggressotropic neuropeptides

Experimental data of physiological activity of synthetic analogs of three novel neuropeptides isolated from the bovine brain are presented. The characteristics of the influence of the peptides on various forms of aggressivity of rats--intermale, predatory, and defense--with central and peripheral administration, are demonstrated. The influence of the peptides on other types of behavior--the consumption of food and water, fear, locomotor activity--associated with the formation of aggression is demonstrated. The modulatory effects of the peptides on the responses of identified neurons of molluscs to neuromediators, serotonin, dopamine, and glutamate, which participate in the neurochemical support of aggressive behavior of rats, are documented.

Time-dependent effects of PCPA on social aggression in chicks

We investigated the effects of para-chlorophenylalanine (PCPA), a serotonin (5-HT) antagonist, on social aggression and brain neurochemistry in young domestic chickens (Gallus domesticus). In Experiment 1, the effects of four different doses of PCPA (0, 100, 200, and 400 mg/kg) were examined for 3 days after injection. Immediately after PCPA injection, aggressive pecking was low and then increased over the 3-day test period. PCPA significantly decreased 5-HT, 5-hydroxyindoleacetic acid (5-HIAA), and 5-HT turnover. In addition, the frequency of aggression was negatively correlated with levels of 5-HIAA. In Experiment 2, the time-dependent effects of a single 400-mg/kg dose of PCPA were examined for 5 and 7 days after drug exposure. PCPA-treated chicks observed for 5 days after injection had significantly greater frequencies of aggression 4 days following drug exposure and significantly reduced 5-HT levels when measured on the next day. Similarly, chicks observed for 7 days exhibited significantly elevated aggression 5 days after injection, after which their pecking decreased to control levels on days 6 and 7. Coinciding with this behavioral pattern, 5-HT levels from these PCPA-treated chicks when assessed 7 days after drug exposure were the same as those for control birds. We concluded that PCPA increased social aggression in birds, an effect that diminished as brain 5-HT levels recovered over a 1-week period.

Tonic immobility and high-intensity calls in a precocial chick as a function of age, diet, and time of day

Tonic immobility (TI) and high-intensity vocalizations are two antipredator behaviors employed by domestic chicks (Gallus gallus) which vary in their function and the proximate mechanisms that govern them. In the present study, we sought to determine the influence of age (3 or 10 days old), diet (control or tryptophan-free), and time of testing (A.M. or P.M.) on the duration of TI and the number of calls produced in domestic chicks. Older chicks remained immobile significantly longer than younger chicks as did subjects on the control diet or those tested at night. However, 3-day-old chicks had significantly shorter TI durations only when tested in the A.M.: TI did not differ between age groups when subjects were tested in the P.M. Three-day-olds called significantly more than 10-day-olds when given the control diet and when tested in the P.M. but vocalization frequencies did not differ between age groups during the A.M. testing or when given the tryptophan-free diet (T-). Vocalization rate (calls/TI duration), however, was significantly greater during the A.M. testing. These results emphasize the importance of considering circadian rhythms and behavioral development. Furthermore, an integrative view of the proximate mechanisms and adaptive functions of TI and high-intensity vocalizations is presented.

Evaluation and treatment of rage in children and adolescents

Rage is characterized by an unpredictable and primitive display of violence that is out of proportion to the provoking event and often threatens serious self-injury or harm to others. New insight into the pathogenesis of unpredictable violent behavior has been gained largely as a result of neurochemical, neuropsychological and brain imaging studies. This article examines episodic rage from a neuropsychiatric perspective. Three cases illustrating the evaluation and treatment of rage in childhood and adolescence are presented.