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Int J Law Psychiatry. 2013 May-Aug;36(3-4):258-63. doi: 10.1016/j.ijlp.2013.04.017. Epub 2013 Apr 30.

Pharmacotherapy of impulsive aggression: a quality comparison of controlled studies.

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Division of Forensic Psychiatry, Department of Neurology and Psychiatry, Saint Louis University School of Medicine, Saint Louis, MO 63104, United States.


The present study assessed the quality of pharmacotherapy trials to treat impulsive aggressive behavior. While a search of the literature found 55 peer-reviewed published studies on the pharmacotherapy of aggression, only 23 met criteria for inclusion in the quality analysis. To be included in this review, the study must have had at least one comparison group to control for placebo effects. The study must have also adequately defined and diagnosed the presence of impulsive aggression or intermittent explosive disorder. The primary reason studies were excluded from the quality analysis was that impulsive aggression was not specifically defined as the behavior being treated (25 of 32, 78%). The results of the quality analysis found that higher quality studies (n=10; 45%) were characterized by a clear definition of impulsive aggression; specific criteria for what constitutes an impulsive aggressive act; the exclusion of participants with neurological disorders, serious mental disorders, and/or low IQ; and information concerning the serum levels of the medication being investigated. A significant weakness found in the literature is the paucity of high quality studies accessing the efficacy of pharmacological agents other than anticonvulsants for the treatment of impulsive aggression.

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