The effects of phenytoin on impulsive and premeditated aggression: a controlled study

Studies of the effects of phenytoin on aggression have produced equivocal results primarily because of a lack of (1) common objective criterion measures of aggressive acts across studies; (2) rigorous inclusion and exclusion criteria for selecting subjects; and (3) a nosologic basis for classifying different types of aggression. The current study was designed to remedy these deficiencies. Aggression was defined using a nosology that defines three types of aggression: (1) medically related; (2) premeditated; and (3) impulsive. The purpose of this study was to test the hypothesis that phenytoin will decrease impulsive aggressive acts but not have a significant influence on premeditated aggressive acts. Sixty inmates were divided into two groups on the basis of committing primarily impulsive aggressive acts or premeditated aggressive acts while in prison. Medical aggression was ruled-out by subject selection. The study used a double-blind, placebo-controlled, crossover design. As hypothesized, phenytoin (200 mg a.m. and 100 mg p.m.) significantly reduced impulsive aggressive acts but not premeditated aggressive acts. Event-related potentials (ERPs) measured information processing in the cortex during drug/placebo conditions. The amplitudes of P300 ERP waveforms among impulsive aggressive subjects were increased significantly during the phenytoin condition but not during the placebo condition. There were no significant changes in P300 ERP waveforms between drug/placebo conditions among nonimpulsive aggressive subjects.     

Increasing program effectiveness through indigenous program evaluation.

Program evaluation studies have concentrated on macro systems, sophisticated research designs, powerful statistics, and limited settings approaches. Such research seems to have little impact on role function or service delivery at the individual psychologist's level. Peer reviews, practice audits, and continuing education are concepts with methods that improve the effectiveness of individual psychologists, but similar concepts with methods for improving programs are few. A procedure, systematic internal review, is discussed that provides concepts and a methodology to evaluate and improve the functioning and effectiveness of programs. This approach has a direct impact on the professional life of the psychologist and the program in which he or she works. Examples of this model are provided from the perspective of an inpatient drug abuse program, but the model is applicable to multiple settings. (8 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Comparison of Anticonvulsants in the Treatment of Impulsive Aggression.

This study compared the behavioral effects of 3 anticonvulsants in impulsive aggressive men. In a double-blind, placebo-controlled, parallel groups design, participants were randomly assigned to 1 of 4 6-week treatments: phenytoin (n = 7), carbamazepine (n = 7), valproate (n = 7), or placebo (n = 8). The efficacy measure was the average aggression score, a global severity index from the Overt Aggression Scale (J. M. Silver & S. C. Yudofsky, 1991). Analysis showed a significant reduction in impulsive aggression during all 3 anticonvulsant conditions compared with placebo. However, the treatment effect during carbamazepine administration was slightly delayed compared with phenytoin and valproate. These findings suggest that increased use of anticonvulsants could make a significant impact in the control of impulsive aggression in both mental health and criminal justice settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An open trial of sertraline in personality disordered patients with impulsive aggression

BACKGROUND: Biological studies suggest that an abnormality in CNS serotonergic functioning underlies the impulsive, aggressive, and self-destructive behaviors of personality disordered patients. Preliminary data suggest that these behaviors may respond preferentially to agents with serotonergic-enhancing properties. This study evaluated the effectiveness of sertraline, a serotonin selective reuptake inhibitor, as a treatment for irritability and aggression in personality disordered patients. METHOD: Eleven patients meeting DSM-III-R criteria for at least one personality disorder were treated with sertraline in an open clinical trial with a flexible dosing schedule. Behavioral ratings for impulsive aggressive behavior and irritability were made at baseline and at Weeks 2, 4, and 8 using a semistructured interview--the Overt Aggression Scale. RESULTS: Nine of 11 patients completed at least 4 weeks of treatment, and 7 patients completed an 8-week trial. Significant changes from baseline on both irritability and overt aggression were noted by the end of 4 weeks, and improvement continued to occur through Week 8. CONCLUSION: This study suggests that sertraline is an effective treatment for impulsive aggressive behavior in personality disordered patients. It supports the hypothesis that different symptom constellations/personality traits have different underlying biological substrates that may respond differentially to pharmacologic agents with specific modes of action. Controlled studies are needed to evaluate the effectiveness of sertraline and other seronergic agents in the treatment of various dimensions of personality psychopathology.     

Serotonin 5-HT1A and 5-HT? receptors in an impulsive–aggressive phenotype.

In adult male hamsters, individual differences in offensive aggression are correlated with differences in impulsive choice and decreased serotonin (5-HT) innervation. As serotonin 1A (5-HT1A) receptors participate in the inhibition of aggression, whereas 5-HT?receptor activation facilitates aggression, the authors hypothesized that differences in their expression are associated with differences in behavior. The authors confirmed previous behavioral associations, using a delay-discounting paradigm with various delays, as high-aggression (H-Agg) hamsters preferred the immediate-reward lever over the delayed-reward lever under most delays, compared with low-aggression (L-Agg) hamsters. Although the authors observed a greater density of 5-HT1A receptor immunoreactivity in H-Agg hamsters within several areas, it appears to be related to a lack of serotonin release, as supported by further observations of decreased immunoreactive perikarya and 5-HT1A receptors in fluoxetine-treated hamsters. Also, 5-HT? receptor density was greater in H-Agg hamsters within select areas. The data indicate a convergence of impulsive and aggressive characteristics to one phenotype that is associated with various aspects of serotonin function, such as serotonin release and differential expression of 5-HT1A and 5-HT? receptors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

CSF testosterone and 5-HIAA correlate with different types of aggressive behaviors

We studied the potential roles of testosterone and serotonin in various forms of aggressive and violent behaviors by measuring each biochemical and behaviour in free-ranging adolescent male nonhuman primates. Our results showed that (1) CSF free testosterone concentrations were positively correlated with overall aggressiveness, but not with measures of impulsivity. (2) CSF 5-HIAA concentrations were negatively correlated with impulsive behavior, and severe, unrestrained aggression, but not with overall rates of aggression. High rates of impulsive behavior were positively correlated with severe, unrestrained aggression, but not overall rates of aggression. (3) Dimensional analyses showed that while subjects with low CSF 5-HIAA exhibited high rates of aggression, high CSF testosterone further augmented rates and intensity of aggression in subjects with low CSF 5-HIAA. We conclude that high CSF free testosterone concentrations are associated with competitive aggression, while low CSF 5-HIAA concentrations are associated with severe aggression which results from impaired impulse control, and perseverance.     

Disinhibitory psychopathology: A new perspective and a model for research.

The syndrome produced by septal lesions in animals can serve as a functional research model of human disinhibitory psychopathology which appears to span several traditionally separate psychological categories—psychopathy, hysteria, hyperactivity, antisocial and impulsive personality, and alcoholism. It is proposed that these categories are separate manifestations of the same genetic diathesis and that the "septal syndrome" may constitute a valid model of behavioral aspects of this diathesis. A program of experimentation utilizing this animal model is outlined. (65 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Emotional arousal and aggressive behavior

Reviews evidence that (a) supported the proposition that general emotional arousal facilitates aggression in the presence of aggressive cues and (b) substantiated the position that an arousal state of anger specifically increases the instigation to aggression. Furthermore, research is reviewed which supports the view that additional general arousal increases or decreases the effect of anger on aggression, depending on whether the arousal state is attributed to the source of the anger or to another source of general arousal. Controversy about the anger/aggression relation is discussed in terms of the failure to specify the function of the aggressive response. Research revealed that if the aggressive response is directed primarily toward injuring the target (but not toward some other goal), an angered person expresses aggression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Relapse prevention.

Reviews the book, Relapse prevention by G. Alan Marlatt and Judith R. Gordon. The book is well suited for its intended audience-clinicians and researchers working in the field of addictions. Clinicians and program developers will appreciate the clear clinical conceptualization of the addiction treatment program and the comprehensive and detailed array of treatment methods that are directly linked to the model. Clinicians working in specialized addiction programs will benefit from the chapters from the contributing authors which outline programmatic approaches for dealing with these behaviors. Clinicians outside the addiction field certainly will find the model and strategies useful in conceptualizing and facilitating the maintenance of behavior change in all types of clients. For researchers, the book will be a rich resource of research ideas and future research directions, and a model for integrating research with practice. It is still uncommon, but much appreciated, to see a true scientist-practitioner like Marlatt who uses research findings to improve treatment and treatment observations to pose research questions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Parent motivation to enroll in parenting skills programs: A model of family context and health belief predictors.

In this study, the authors tested a heuristic model of health belief and family context factors associated with parent inclination to enroll in parenting skills programs. They collected data from 1,192 rural midwestern parents of 5th graders. Results support a basic model including health belief constructs derived from the health belief model (I. M. Rosenstock, 1966; perceived teen problem susceptibility, problem severity, program benefits, and program barriers) and an expanded model incorporating the indirect effects of several family context variables, household income, parent education, number of children, child problem behaviors, and past parenting resource use. Perceived program benefits, program barriers, and past parenting resource use showed the strongest influence on the parents' inclination to enroll. Implications for practitioners are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Vasopressin and serotonin interactions in the control of agonistic behavior

In hamsters, dominant/subordinate relationships are initially determined by overt aggression, but subsequently communicated by flank marking, an arginine vasopressin (AVP)-dependent behavior. Once a relationship is established, dominant males will flank mark at a higher frequency than their subordinate partners. Flank marking displayed during social encounters can be turned "on or off" by microinjection of AVP or AVP-receptor antagonist within the anterior hypothalamus (AH). For instance, microinjecting dominant hamsters with AVP-receptor antagonist blocks their flank marking and provokes an immediate induction of flank marking by subordinate animals. The central effects of AVP have been extended to include a role in offensive aggression. Microinjection of AVP-receptor antagonist into the AH inhibits the aggression of a resident hamster toward an intruder and diminishes aggression between hamsters placed into a neutral arena. Microinjection of AVP into the ventrolateral hypothalamus (VLH) facilitates offensive aggression of a resident toward an intruder. As AVP receptors in the VLH are testosterone-dependent, it is possible that the reduction of aggression observed in castrated hamsters is due to a loss of AVP responsiveness in the VLH. Recent work has focused on the notion that serotonin (5-HT) antagonizes AVP activity in the CNS. The AH and VLH have a high density of 5-HT terminals and binding sites. Indeed, there appear to be 5-HT synapses on AVP neurons in the AH. Microinjection of 5-HT into the AH inhibits AVP-induced flank marking while IP injection of fluoxetine a serotonin reuptake inhibitor inhibits AVP-induced offensive aggression in the VLH. It is possible that serotonin interacts with AVP to modulate offensive aggression.     

Interventions for intimate partner violence: Review and implications for evidence-based practice.

The objective of this article was to survey available intimate partner violence (IPV) treatment studies with (a) randomized case assignment, and (b) at least 20 participants per group. Studies were classified into 4 categories according to primary treatment focus: perpetrator, victim, couples, or child-witness interventions. The results suggest that extant interventions have limited effect on repeat violence, with most treatments reporting minimal benefit above arrest alone. There is a lack of research evidence for the effectiveness of the most common treatments provided for victims and perpetrators of IPV, including the Duluth model for perpetrators and shelter–advocacy approaches for victims. Rates of recidivism in most perpetrator- and partner-focused treatments are approximately 30% within 6 months, regardless of intervention strategy used. Couples treatment approaches that simultaneously address problems with substance abuse and aggression yield the lowest recidivism rates, and manualized child trauma treatments are effective in reducing child symptoms secondary to IPV. This review shows the benefit of integrating empirically validated substance abuse and trauma treatments into IPV interventions and highlights the need for more work in this area. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive mediators of aggression in adolescent offenders: II. Intervention.

A 12-session intervention program, based on a model of social–cognitive development, was designed to remediate cognitive factors identified as correlates of aggression (R. G. Slaby and N. G. Guerra; see record 1989-01839-001). 120 male and female adolescents incarcerated for aggression offenses participated in either the cognitive mediation training program, an attention control group, or a no-treatment group. Compared with Ss in both control groups, Ss in the treatment group showed increased skills in solving social problems, decreased endorsement of beliefs supporting aggression, and decreased aggressive, impulsive, and inflexible behaviors, as rated by staff. Posttest aggression was directly related to change in cognitive factors. No group differences were detected for number of parole violators up to 24 months after release. The ways in which changes in cognitive skills and beliefs may mediate changes in aggressive behavior are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Early syphilis in an active duty military population and the surrounding civilian community, 1985-1993

The study of human aggression has been hindered by the lack of reliable and valid diagnostic categories that specifically identify individuals with clinically significant displays of impulsive aggressive behavior. DSM intermittent explosive disorder (IED) ostensibly identifies one such group of individuals. In its current form, IED suffers from significant theoretical and psychometric shortcomings that limit its use in clinical or research settings. This study was designed to develop a revised criteria set for IED and present initial evidence supporting its reliability and validity in a well characterized group of personality disordered subjects. Accordingly, research criteria for IED-Revised (IED-R) were developed. Clinical, phenomenologic, and diagnostic data from 188 personality disordered individuals were reviewed. IED-R diagnoses were assigned using a best-estimate process. The reliability and construct validity of IED-R were examined. IED-R diagnoses had high interrater reliability (kappa = .92). Subjects meeting IED-R criteria had higher scores on dimensional measures of aggression and impulsivity, and had lower global functioning scores than non-IED-R subjects, even when related variables were controlled. IED-R criteria were more sensitive than DSM-IV IED criteria in identifying subjects with significant impulsive-aggressive behavior by a factor of four. We conclude that in personality disordered subjects, IED-R criteria can be reliably applied and appear to have sufficient validity to warrant further evaluation in field trials and in phenomenologic, epidemiologic, biologic, and treatment-outcome research.     

Divalproex sodium for impulsive aggressive behavior in patients with personality disorder

OBJECTIVE: Divalproex sodium, an anticonvulsant and antimanic agent, has recently been studied for its antiaggressive effects in patients with brain injuries, dementia, and borderline personality disorder. Since patients with other personality disorders also exhibit impulsive aggressive behavior, we conducted a preliminary open-label trial of divalproex sodium as a treatment for irritability and aggression in patients with a variety of personality disorders. METHOD: Ten patients meeting DSM-IV criteria for at least one personality disorder were treated with divalproex sodium in an 8-week open clinical trial. All patients had failed a trial of a selective serotonin reuptake inhibitor (SSRI). Divalproex sodium was increased as tolerated using a flexible dosing schedule. Clinician ratings for impulsive aggressive behavior and irritability were made every 2 weeks using the modified Overt Aggression Scale (OAS-M). RESULTS: Six of 8 completers reported significant decreases in irritability (p = .003) and impulsive aggressive behavior (p = .019). For the entire sample, improvement on OAS-M irritability and overt aggression scores was noted by the end of 4 weeks and continued to occur through week 8. CONCLUSION: This study suggests that divalproex sodium is an effective treatment for impulsive aggressive behavior in some patients with personality disorder who fail to respond to other antiaggressive agents (i.e., SSRIs). Controlled studies are needed to determine which patients are most likely to benefit from divalproex sodium and to evaluate the differential effectiveness of various agents in reducing impulsive aggressive behavior.     

Isolation rearing enhances the locomotor stimulant properties of intra-perifornical sulpiride, but impairs the acquisition of a conditioned place preference

This article synthesizes theoretical material from psychology research into a practical model for conceptualizing violence in psychiatric settings. Relevant research and theory are reviewed, focusing on two important behavioral models of aggressive behavior, hostile aggression and instrumental aggression. The concepts of reinforcement, anticipated rewards, specific and nonspecific stimulus-driven aggression, intermediary emotional states in aroused persons, and the aggression stimulus threshold are developed into a bimodal model applicable to the clinical management of violence. The model provides a broad framework for categorizing, understanding, and addressing aggressive behavior in clinical settings.     

Effects of erotic stimuli on male aggression toward females.

To examine the effects of highly erotic films on aggression toward females, 72 male undergraduates were first either angered or treated in a neutral manner by a male or female confederate. After viewing a highly erotic or a neutral film, Ss were given an opportunity to both aggress against and reward the confederate. Erotic films were found to increase aggression overall, but there was no indication of differential aggression as a function of sex of target. Results for physiological arousal, however, suggested that aggression was possibly inhibited for Ss exposed to an erotic film and paired with a female. Suggestions for future lines of research based on the notion of inhibition are offered, along with observations regarding the sexual arousal and aggression relationship. (31 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reliability-Based Optimization Considering Manufacturing and Operational Uncertainties

This paper presents approaches for integrating multidisciplinary optimization and probabilistic methods to perform reliability-based multidisciplinary optimization. The approaches are built into a framework that allows solution of optimization problems, wherein system parameters including dimensional tolerances, material properties, boundary conditions, loads, and model predictions are uncertain or variable. This approach directly supports quality engineering because it allows engineers to specify manufacturing tolerances required to achieve the desired product reliability, and it results in robust designs that are optimal over the range of variable conditions because it considers uncertainties during the optimization process. The basic reliability-based multidisciplinary optimization methodology has been demonstrated to design engine components, aircraft lap joints, and transport aircraft wings. Herein this methodology is reviewed and then the focus is on demonstrating a new framework that makes it possible to use these methods with commercial CAD∕CAE tools and support commercial shape parameterization to enable shape optimization and consideration of manufacturing uncertainties.     

Deconvolution of chemiluminescent emission curve associated with phagocytosis into three logarithmic normal distributions

5-Hydroxytryptophan (5-HTP) is the intermediate metabolite of the essential amino acid L-tryptophan (LT) in the biosynthesis of serotonin. Intestinal absorption of 5-HTP does not require the presence of a transport molecule, and is not affected by the presence of other amino acids; therefore it may be taken with meals without reducing its effectiveness. Unlike LT, 5-HTP cannot be shunted into niacin or protein production. Therapeutic use of 5-HTP bypasses the conversion of LT into 5-HTP by the enzyme tryptophan hydroxylase, which is the rate-limiting step in the synthesis of serotonin. 5-HTP is well absorbed from an oral dose, with about 70 percent ending up in the bloodstream. It easily crosses the blood-brain barrier and effectively increases central nervous system (CNS) synthesis of serotonin. In the CNS, serotonin levels have been implicated in the regulation of sleep, depression, anxiety, aggression, appetite, temperature, sexual behaviour, and pain sensation. Therapeutic administration of 5-HTP has been shown to be effective in treating a wide variety of conditions, including depression, fibromyalgia, binge eating associated with obesity, chronic headaches, and insomnia.