Violent behavior: Choosing antipsychotics and other agents
Therapeutic options depend on whether patient violence is transient or persistent.
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.
