Impulsive aggression: recognition and choice of pharmacotherapy

Abstract

Instrumental (controlled) aggression is observed in populations of both mentally healthy and mentally ill people. This type of aggression is not associated with any specific pathophysiological changes and cannot be considered as an independent symptom, which might be a target of pathogenetic therapy. By contrast, impulsive aggression is a paroxysm of anger, based on affectively narrowed consciousness when volition control is significantly reduced or absent. Impulsivity is different from cognate compulsivity by the loss of a stage of intellectual processing of affectively painted representations and by that the irrational attraction to action is realized involuntary, automatic. All impulsive-behavior patients are united by common pattern of neurobiological abnormalities, such as deficit of frontal inhibition of subcortical unconscious emotions and inclinations in response to relevant arousing stimuli. The results from evidence-based research, meta-analyses and Cochrane reviews of efficiency of pharmacological agents used for reduction of impulsive aggressive behavior were summarized.