Pharmacotherapy of Primary Impulsive Aggression in Violent Criminal Offenders

Alan R Felthous,Matthew S Stanford,Fulvio Carabellese,Jose Bou Nassif,Ellen Kim,Bridget Mccoy,Rajat Duggirala

doi:10.3389/fpsyg.2021.744061

Alan R Felthous, Matthew S Stanford + Show 5 more

Open Access

https://doi.org/10.3389/fpsyg.2021.744061

Copy DOI

Abstract

Primary impulsive aggression (PIA) can be implicated as a common factor that results in an arrest, disciplinary, and restraint measures during confinement, and criminal recidivism after release. Evidence suggests that anti-impulsive aggression agents (AIAAs) can diminish or prevent impulsive aggression even when occurring with personality pathology such as borderline or antisocial personality disorder (ASPD), common conditions in offender populations. A previous review identified agents that have been subjected to controlled drug trials of sufficient quality, and subsequently, a decisional algorithm was developed for selecting an AIAA for individuals with IA. This selection process began with the five agents that showed efficacy in two or more quality studies from the earlier review. Today, 8 years after the quality review study, the present authors undertook this follow-up literature review. The aims of the present review were to survey the literature to identify and assess: (1) drug trials of comparable quality published since the 2013 review, including trials of the previously identified AIAAs as well as trials of agents not included in the earlier review; (2) severity of aggressive outbursts; (3) the materiality of risks or side-effects that are associated with individual AIAAs as well as antipsychotic agents commonly used to control clinical aggression; (4) efficacy of these agents in special populations (e.g., females); and (5) cost and convenience of each agent. Improved pharmacotherapy of PIA by addressing risks, side effects and practicality as well as the efficacy of AIAAs, should promote the rehabilitation and reintegration of some pathologically aggressive offenders back into the community.

Highlights

Primary Impulsive Aggression and the RNR Principles of RehabilitationThe risk-need-responsivity (RNR; Andrews et al, 1990) principles have in recent years provided a conceptual model for the rehabilitation of criminal offenders (Wong and Gordon, 2013; Wong and Olver, 2015)
While we have focused on evidence supporting anti-impulsive aggression agents (AIAAs), there are many other agents commonly prescribed for impulsive aggression, studies to support their efficacy in treating primary impulsive aggression (PIA) are lacking
More research is needed on each of these before any are advanced to FDA approval for PIA or intermittent explosive disorder (IED), and other candidate drugs remain to be adequately tested for efficacy in treating PIA

Summary

Introduction

Primary Impulsive Aggression and the RNR Principles of RehabilitationThe risk-need-responsivity (RNR; Andrews et al, 1990) principles have in recent years provided a conceptual model for the rehabilitation of criminal offenders (Wong and Gordon, 2013; Wong and Olver, 2015). The RNR model typically includes psychotherapy, environmental adjustments, and social service programs to address the individual’s needs in order to reduce the specific risks that predispose to the general risk of failure of rehabilitation, in this case, aftercare. This approach takes into account the individual’s responsivity or amenability to the proposed treatment. Andrews and Bonta (2010) proposed the RNR model in 1990 as core to effective programming to assess and reduce recidivism It has since been utilized in criminal justice systems in many countries, including parts of the United States. Further studies looking at the role of pharmacologic treatment for PIA in correctional settings may add to the literature regarding the implementation of the RNR and other similar models targeting antisocial patterns

Objectives

Discussion

Conclusion