Evidence-Based Reviews

Violent behavior: Choosing antipsychotics and other agents

Current Psychiatry. 2007 April;6(4):63-70

References

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Behavioral techniques can decrease violence by addressing specific impairments underlying the violence. For example, improving a patient’s cognitive functioning can counter impaired processing of feedback that is associated with neurological dysfunction.

Specific interventions, such as cueing to exaggerate the link between stimulus and response, could be beneficial.²⁷ Similarly, these patients might respond to a high degree of structure, supervision, and specific environmental modifications, such as transfer to a unit that specializes in treating violent patients.²⁸

In cognitive-behavioral therapy, patients can learn ways they can satisfy their needs without being violent. They also can be trained in problem-solving skills and in understanding the consequences of their actions. Such therapy might be useful for diminishing antisocial traits. Interventions aimed at preventing, decreasing, or counteracting arousal are important in addressing acute violence.

Anger management programs can help patients respond to interpersonal provocations in a more adaptive way.²⁹ These programs include:

education about aggression
self-monitoring of anger frequency, intensity, and situational triggers
relaxation to reduce arousal and enable guided imagery training
training in behavioral coping, communication, and assertiveness through role play
practicing new anger-coping skills.³⁰

Tailor treatments to the dominant mechanisms underlying persistent violence.

Related resources

Citrome L, Volavka J. Aggression. eMedicine from WebMD. www.emedicine.com/med/topic3005.htm.
Davidson RJ, Putnam KM, Larson CL. Dysfunction in the neural circuitry of emotion regulation—a possible prelude to violence. Science 2000;289:591-94.

Drug brand names

Carbamazepine • Carbatrol, Equetro, Tegretol
Clozapine • Clozaril
Divalproex • Depakote
Haloperidol • Haldol
Lithium • Eskalith, Lithobid
Lorazepam • Ativan
Midazolam • Versed
Nadolol • Corgard
Olanzapine • Zyprexa
Pindolol • Visken
Propranolol • Inderal, Inderide
Quetiapine • Seroquel
Risperidone • Risperdal
Valproate • Depacon
Ziprasidone • Geodon

Disclosure

Dr. Krakowski receives research support from Eli Lilly and Co. and GlaxoSmithKline.