The pharmacological management of aggression

Abstract

The occurrence of aggressive incidents in psychiatric care has a great impact on the well being of staff and patients, and is associated with considerable costs (Cole, 2005; Hunter &Carmel, 1992; Nijman, Bowers, Oud, &Jansen, 2005). Considering the high impact of aggression in mental health care, prevention, and management of aggression should have high priority (Palmer, 1996). Several treatment approaches to manage aggressive behavior exist, including psychopharmacological and behavioral approaches (Morrison, 2003). Observational research has shown that aggressive patients more often use psychotropics compared to nonaggressive patients (Soliman &Reza, 2001; Stolker, 2002). Because in animal and human models of aggression, several neurotransmitters appeared to be implicated in the modulation of aggressive behavior (Miczek, Fish, De Bold, &De Almeida, 2002), it is not surprising that a broad range of psychotropics has been investigated for their antiaggressive properties. However, despite the high prevalence of psychotropic drug use in aggressive patients, evidence for the efficacy of the pharmacological management of aggressive behavior is currently lacking. Lack of evidence is reflected by the existence of a variety of guidelines for the emergency management of aggression, and was stressed in two recent systematic reviews for the maintenance of the pharmacotherapy of aggression dating from 1996 to 1997 (Fava, 1997; Pabis &Stanislav, 1996).