Aggression and psychopharmacological treatments in major psychosis and personality disorders during hospitalisation

BackgroundA number of large-scale studies have shown that there is a relationship between many psychiatric disorders and aggression or violence. As no medication is currently approved for the treatment of aggression, pharmacotherapy (often involving drug combinations) is used on a trial-and-error basis with various degrees of response.MethodThe study involved 244 in-patients aged 19-83 years (mean 41.9 ± 11.3 SD). The Modified Overt Aggression Scale (MOAS) was used to assess any aggressive or violent behaviors occurring in the week before admission and upon discharge.Psychopathology was assessed using the Brief Psychiatric Rating Scales (BPRS).ResultsAll of the patients showed a significant improvement (p < 0.001) in mean weighted total MOAS scores at the end of the study, with no significant differences between the various drugs or combination therapies. The patients who received combination treatments including antidepressants showed a worsening in the weighted total MOAS score (18.46% ± 114.31% SD); the patients who did not receive antidepressants had an improvement (13.61% ± 257.36% SD) (p = 0.0069).ConclusionsMultivariate testing of the variables age, gender, substance/alcohol abuse, the duration of hospitalisation, the administration of mood stabilisers, and the use of typical or atipical antipsychotics showed that the severity of the psychopathological picture correlated significantly with the presence of violence, whereas the effect of combined antidepressant treatment on violent behavior was only relative.

Research highlights► We analyze the relationship between aggression and psychiatric disorders, particularly Major Psychosis and Personality Disorders. ► We examine the effects of psychopharmacological treatments on violent behaviors. ► Patients who receive antidepressants in combination therapy show a worsening of aggression. ► Patients who do not assume antidepressants have an improvement. ► The only factor that seems to have an effect on violence is the insertion of antidepressants in the therapy.