Treatment Of Aggressive Behavior Research Articles

Appropriate treatment targets or products of a demanding environment? The relationship between aggression in a forensic psychiatric hospital with aggressive behaviour preceding admission and violent recidivism

Effective treatment of aggressive behaviour and accurate release decision making are necessary components of adequate clinical practice in forensic psychiatric units. Unfortunately, methods to identify treatment targets and ameliorate aggressive behaviour have developed at a slower pace than risk assessment technologies. Recent progress on the identification of offence paralleling or functionally equivalent behaviour offers a framework for individually tailored treatment and idiographic release decision making, although empirical scrutiny of this approach is inadequate. This paper describes an examination of the relationship between aggressive behaviour prior to admission with aggression during inpatient psychiatric treatment, and reconviction for violent offending following discharge. Results showed a relationship between pre- and post-admission aggression but no relationship between aggression during inpatient psychiatric treatment with either pre-admission aggressive behaviour or violent recidivism. These findings indicate the importance of state psychological variables, specifically those states affected by symptoms of psychiatric illness, as well as environmental activators and inhibitors of violence that operate within the hospital. These require inclusion in an adequate functional analysis of aggressive behaviour for forensic psychiatric patients.

Assessment and treatment of aggressive behavior without a clear social function

We conducted functional analyses of two individuals’ aggressive behavior. Results of each of the initial functional analyses were inconclusive with respect to the role of social reinforcers in the maintenance of the behavior. Further assessment was conducted to clarify the role of social reinforcers. One individual's results suggested social reinforcers were relevant while results for the second individual remained inconclusive. Treatment evaluations conducted with both individuals suggested manipulation of social consequences could be used to reduce aggressive behavior even though, in one case, no clear social function was apparent.

Serotonin transporter characteristics in lymphocytes and platelets of male aggressive schizophrenia patients compared to non-aggressive schizophrenia patients

A large body of literature indicates that disturbances of central serotonin (5-HT) function play an important role in aggressive behavior. Results from open-label and placebo-controlled trials as well as the reported inverse relationship between 5-HT function and aggression in human subjects, suggest that reduced 5-HT activity is associated with aggressive behavior. The activity of the 5-HT transporter (5-HTT), as determined by [3H]5-HT uptake to blood lymphocytes, was measured in 20 currently aggressive and 20 non-aggressive male schizophrenia patients. In addition, the pharmacodynamic characteristics of platelet 5-HTT were assessed by [3H]citalopram binding.There were no significant differences in the density (Bmax) of platelet [3H]citalopram binding sites between the two groups. Similarly, the dissociation constant (Kd) values were indistinguishable. The maximum uptake velocity (Vmax) of [3H]5-HT to fresh lymphocytes and the Km values of the 5-HT to the transporter were significantly higher in currently aggressive compared to the non-aggressive schizophrenia patients. The association of high Vmax values with current aggressive behavior provides further support to the involvement of the 5-HTT in aggressive behavior as well as to the efficacy of 5-HTT blockers in the control of aggression. The role of the various components of the serotonergic system in the pathophysiology and treatment of aggressive behavior in schizophrenia needs to be further evaluated.

Prescribing practices of community child and adolescent psychiatrists

Aims and MethodA questionnaire was sent to all 55 community child and adolescent psychiatrists working in the West Midlands to examine the prescribing practices of community child psychiatrists, because most previous studies have included prescribing data from specialist (tier 4) services.ResultsThe survey had a good response rate (87%). The vast majority of child psychiatrists were prescribing stimulants and antidepressants, and over half were prescribing antipsychotics and melatonin. At least half of the consultants would consider prescribing an antipsychotic for the treatment of aggressive behaviour. One-third of consultants cited pressure on services as a reason for prescribing medication.Clinical ImplicationsCommunity child psychiatrists were prescribing more medication than expected, which may have a considerable impact on referral rates to adult services in the future. It is concerning that the increased use of medication may be a reflection of pressure on services.

Are Children's Concerns About Punishment Related to Their Aggression?

Although moral reasoning is recognized as an influence on students' behavior, it is often overlooked in policies and interventions developed to change their behavior. Relations between specific types of moral reasoning (i.e., imminent, probable, physical, and psychological) and teacher-reported overt aggression were examined in 203 first and second graders. Regression analyses indicated that psychological reasoning explained a significant amount of the variance in overt aggression. Follow-up analyses indicated that overtly aggressive boys demonstrated more concern for the imminent consequences of their behavior on themselves (e.g., punishment) and less concern for the psychological consequences of their actions on others (e.g., hurting others' feelings) than nonaggressive boys. Implications for the prevention and treatment of aggressive behavior are discussed.

Neuropsychiatry and Mental Health Services

Neuropsychiatry and Mental Health Services

Neuropsychiatry and Mental Health Services

Neuropsychiatry and Mental Health Services

Lithium Treatment of Aggressive Behavior in Depressed, Drug-Dependent Patients

Four non-bipolar I methadone-mainte-nance patients with irritability and aggressiveness were treated with lithium. Three had met criteria for childhood conduct disorder and all four had adult antisocial features. In each case there was a noticeable reduction in aggression and an improvement in functioning. This finding suggests that there is a treatable subgroup of drug-dependent patients with antisocial behavior.

Psychopharmacological Treatment of Aggressive Behavior: Implications for Domestically Violent Men

In an attempt to further evolve our understanding and response to domestic violence as a public health problem, a number of investigators have begun to prioritize the development of specialized diagnostic and intervention methods from a biomedical perspective. The potential use of selectively prescribed and carefully monitored medications to help end violent and abusive behavior would be an important step toward mainstreaming the treatment of domestically violent men into the realm of modern medicine and health care. While much work remains in understanding the specific linkages and mechanisms between psychobiology and aggressive and violent behavior, there is a growing body of basic and clinical research which has important potential for expanding our intervention efforts. This article reviews this research in relation to current efforts to understand and treat domestically violent men. A biopsychosocial model which incorporates selective and adjunctive psychopharmacological treatment within the context of cognitive-behavioral and social systems interventions is outlined and discussed.

Aggressive behaviour in dementia and its pharmacologic treatment: A review

Aggression and other behavioural disturbances are frequent in dementia. Aggressive behaviour is associated both with the severity of dementia and with the presence of psychiatric and depressive symptoms and causes great distress for the patients and the caregivers. Both pharmacologic and behavioural strategies are necessary in dealing with these problems. Before treatment, a thorough medical and psychiatric examination is necessary. Neuroleptics are the most frequently used drugs in the treatment of aggressive behaviour in dementia. Empirical research has demonstrated a significant, but moderate, effect for these drugs. However, side-effects are frequent and severe in this group of elderly people with organic brain disease. There are few studies with adequate methods examining alternative drug strategies. However, when aggressive behaviour is associated with depressive symptoms, seizure disorder, anxiety and insomnia, manic symptoms, and Parkinson's disease, alternative drugs like serotonin reuptake inhibitors, carbamazepine, benzodiazepines, lithium, and L-deprenyl should be considered.

ANTICONVULSANTS

In addition to their use in the treatment of seizure disorders and various otherwise treatment-refractory psychiatric cases (e.g. mania), anticonvulsants have pined recognition for their beneficial effect in the treatment of aggressive behavior. In particular, carbamazepine has been consistently shown to be effective in lowering aggression regardless of psychiatric or neurological condition. Empirical studies of the effectiveness of anticonvulsants in decreasing aggression are reviewed and evaluated. Cost benefit factors related to the use of anticonvulsants in the treatment of violent individuals are evaluated. Finally, a protocol for the implementation and monitoring of anticonvulsant treatment is presented.

A trial of eltoprazine in the treatment of aggressive behaviours in two populations: Patients with epilepsy or Gilles de la Tourette's Syndrome

AbstractWe describe an exploratory double‐blind placebo controlled trial of eltoprazine, a novel pharmacological agent, in the management of aggressive behaviours in two groups of patients: patients with epilepsy and patients with Gilles de la Tourette's Syndrome (GTS). The study was brought to a premature close. Two psychotic reactions were observed. This may reflect interactions at the 5HT1 receptor group. Observations are made about the conduct of drug trials of the treatment of aggression in general and the specific clinical response seen in these two groups. We do not find evidence of the clinical value of eltoprazine for the management of aggression in these two groups.

Divalproex Sodium in the Treatment of Aggressive Behavior

Divalproex sodium was given to a series of agitated individuals with a variety of psychiatric illnesses. Objective measures of agitation were then used to assess the effect of the divalproex sodium on such behavior. Demographic, diagnostic, medical, and physiological data were compiled on the subjects and the variation in the amount of time spent in an agitated state was evaluated in an attempt to account for the variation. We found that divalproex sodium reduced agitation in a variety of psychiatric conditions. It seems to be especially effective in the treatment of the agitated patient with bipolar illness or borderline personality disorder.

Factors Influencing Nurses' Acceptability of Treatments for Problem Behaviors of Nursing Home Residents

The effect of treatment options, side effect profile, and time to implement treatment on ratings of the acceptability of treatments was evaluated Differential reinforcement (DRO) received the highest acceptability rating for treatment of aggressive behavior. Time-out and medication were equally acceptable as treatments for disruptive behavior. Side effect profile decreased ratings of all treatments except DRO. Time involvement and side effect profile resulted in equivalent ratings for disruptive behavior. The use of the least restrictive intervention for disruptive behavior may be especially difficult due to the low ratings of DRO. These results suggest that the time required to use applied behavior analysis interventions in nursing homes is not an impediment to use of such procedures.

Case Report: Development of Precocious Puberty in Two Children Treated with Clonidine for Aggressive Behavior

ABSTRACT Clinical symptoms of precocious pubertal development were observed in two girls with mild mental retardation during treatment of aggressive behavior with clonidine. Both 7-year-old children developed early physical signs of puberty, whose progression ceased when clonidine was discontinued. Prior to treatment with clonidine, both patients had received several different psychoactive medications without any signs of onset of puberty. Biochemical confirmation of the diagnosis and evaluation of concomitant medical conditions were unobtainable due to individual circumstances. Based on the appearance of clinical symptoms of precocious puberty, it is hypothesized that clonidine may have stimulated the production or release of anterior pituitary hormones. If physical signs of precocious puberty appear during treatment with clonidine, clinicians might consider the possibility of a link to the medication as well as to pursue possible medical causes of precocious puberty.

The effect of timeout duration on frequency of aggression in hospitalized children with conduct disorders

AbstractTimeout has been shown to be an effective procedure in the treatment of aggressive behaviors. Previous research, however, has not provided evidence to support the use of a particular timeout duration in the treatment of aggressive behavior. This study compared the effectiveness of four different timeout durations (1, 5, 10, and 20 min) in the treatment of aggressive behavior in hospitalized children with conduct disorders. Results did not support the use of extended periods of timeout, but suggested that 5 min duration was as or more effective than the other tested durations.

A Neurobehavioral Perspective of Aggressive Behavior

Aggressive behavior is a common symptom of brain injury. A careful neurological evaluation frequently will reveal contributing factors that are important for treatment. New pharmacologic therapies offer new approaches to the symptomatic treatment of aggressive behavior. Legal implications of these new treatments also are discussed.

Lithium Carbonate for Aggressive Behavior or Affective Instability in Ten Brain-injured Patients

Lithium carbonate (LiCO3) was used to treat 10 brain-injured patients with severe, unremitting, aggressive, combative, or self destructive behavior or severe affective instability. Five patients had a dramatic response that resulted in significant improvement in their participation in a rehabilitative program. One other patient had a moderate response. A seventh patient improved dramatically, but regressed after 7 wk. Three other patients had neurotoxic side effects that precluded continued use of the medication. Two of them were simultaneously taking neuroleptic agents. These case reports provide further evidence that LiCO3 can be a useful medication in the treatment of aggressive behavior and affective instability after brain injury, but that it has significant potential for neurotoxicity in this population, particularly when used in conjunction with neuroleptic agents.

Aggressive behavior in hospitalized psychogeriatric patients.

The frequency and characteristics of aggressive and hostile behavior in 40 psychogeriatric inpatients was investigated using the Staff Observation Aggression Scale (SOAS). Most aggressive acts were directed towards nursing staff when providing help with activities of daily living. A positive correlation was found between age and the frequency of aggressive behavior, while severity was most strongly correlated to length of admission. A significant decrease in frequency was observed during the six weeks of observation. The causes of this decrease are discussed together with the implications for future studies on the treatment of aggressive behavior in this group of patients.

A guide to the literature on aggressive behavior

A guide to the literature on aggressive behavior