LIST REFERENCES LIST REFERENCES A) RAGE... 16 L) AGGRESSION 10628 B) ANGER 1746 M) VIOLENCE 4492 C) HATE 149 N) *SUM LM 15120 D) HOSTILITY 1925 O) *ON J&N 600 E) RAGE 98 P) ABSTRACT ONLINE 2667279 F) *SUM ABCDE 4134 Q) *ON O&P 200 G) HOSTILITY /DT 1 R) 1990...91 529664 H) TREATMENT 259692 S) *ON Q&R 21 I) THERAPEUTICS 2791 T) PANIC 2037 J) *SUM HI 262483 U) *SUM ABCDELM 19254 K) *ON F&J 139 V) *ON T&U 20 *** *** *****AMERICAN JOURNAL OF PSYCHIATRY***** (REFERENCE 1 OF 39) 85020399 The origin and treatment of rage attacks [letter] Am J Psychiatry 1984 Oct;141(10):1304-5 [No Abstract Available] (REFERENCE 2 OF 39) 84101842 Yudofsky SC Stevens L Silver J Barsa J Williams D Propranolol in the treatment of rage and violent behavior associated with Korsakoff's psychosis. Am J Psychiatry 1984 Jan;141(1):114-5 Propranolol controlled the rage and violent behavior of a man with alcohol withdrawal, Korsakoff's psychosis, and seizures. The uthors present evidence linking Korsakoff's psychosis and alcohol withdrawal to pathophysiologic alterations in CNS adrenergic amines and receptors. (REFERENCE 3 OF 39) 81107003 Yudofsky S Williams D Gorman J Propranolol in the treatment of rage and viole behavior in patients with chronic brain syndromes. Am J Psychiatry 1981 Feb;138(2):218-20 The authors successfully treated four patients who had irreversible CNS lesions and socially disabling aggressiveness and outbursts of rage, which had not been affected by high doses of major tranquilizers or anticonvulsants, with 320-520 mg/day of propranolol. Disrientation, memory impairment, and psychotic thought processes associated with the CNS lesions were not altered by the propranolol. (REFERENCE 4 OF 39) 77154967 Madden DJ Voluntary and involuntary treatment of aggressive patients. Am J Psychiatry 1977 May;134(5):553-5 The author describes his experiences in treang violent patients in group therapy. Problems include the divergent goals of therapist, patient, and society; the environmental limitations on incarcerated patients; countertransference issues; and magical expectations on the part of patients. Therapeutic goals must be somewhat limied with patients who are forced into therapy. It may be dangerous to "open up" such patients, especially when they face lengthy prison terms. The author suggests that distancing tactics be avoided with violent patients, who need to encouter another person who has dealt successfully with hatred, fear, and limitations. (REFERENC 5 OF 39) 90289827 Fav M Anderson K Rosenbaum JF "Anger attacks": possible variants of panic and major depressive disorders. Am J Psychiatry 1990 Jul;147(7):867-70 The authors report a series of illustrative cases in which patients presented with sudden "spells" of anger with physical features that resembled panic attacks but lacked the affects of fear and anxiety. These spells or "attacks" of anger were eperienced as uncharacteristic and were inappropriate to the situations in which they occurred. Since treatment of these attacks with antidepressants produced in each case marked improvements in behavior, th author also formulate some hypotheses as to the nature of theepisodes. Institutional address: Clinical Psychopharmacology Unit Massachusetts General Hospital Boston 02114. (REFERENCE 6 OF 39) 88250470 Yudofsky SC Silver JM Panic and aggression in organic brain syndrome [letter] Am J Psychiatry 1988 Jul;145(7):907-8 [No Abstract Available] *****ARCHIVES OF GENERAL PSYCHIATRY***** (REFERENCE 7 OF 39) 84230479 Platt JE Campbell M Green WH Grega DM Cognitive effects of lithium carbonate and haloperidol in treatment- resistant aggressive children. Arch Gen Psychiatry 1984 Jul;41(7):657-62 The effects of lithium carbonate and haloperidol on cognition were examined in a placebo-controlled, double-blind study of 61 treatment- resistant, hospitalized school-aged children. They all had a DSM-III diagnosis of conduct disorder-- undersocialized , aggressive, with a profile of highly explosive and aggressive bhavior. Children were assessed at the end of a two-week placebo-baseline period and again after fourweeks of treatment. Drug effects on cognition were mild. Haloperidol (mean dose, 2.95 mg/day) caused significant decreases in Porteus Maze test quotient scores and a slowing of reaction time (RT) on a simple RT task. Lithium carbonate (mean dose, 1,166 mg/day) adversely affected qualitative scores on the Porteus Maze test. No significant treatment effects were found for the Matching Familiar Figures Test, short-term recognition memory and concept attainment tasks, or the Stroop Test. *****ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION**** (REFERENCE 8 OF 39) 90314744 Szabowicz JW Stewart JT Amitriptyline treatment of agitation associated with anoxic encephalopathy. Arch Phys Med Rehabil 1990 Jul;71(8):612-3 A 43-year-old man exhibited agitation and nondirected aggression related to anoxi encephalopathy after a myocardial infarction. These symptoms abated upon treatment with amitriptyline, only to return upon its inadvertent discontinuation. The drug was well tolerated, in contrast to neuroleptics, which are frequently associated with serious side effects in this population. Although further experience is needed, amitriptyline may be an effective treatment option in agitation associated with anoxic encephalopathy. Institutional address: Brain Injury Rehabilitation Team Gainesville VA Medical Center FL. *****JOURNAL OF CLINICAL PSYCHIATRY***** (REFERENCE 9 OF 39) 91201246 Ratey J Sovner Parks A Rogentine K Buspirone treatment of aggression and anxiety in mentally retarded patients: a multiple-baseline, placebo lead-in study. J Clin Psychiatry 1991 Apr;52(4):159-62 Buspirone, a new anxiolytic agent, was used in a multiple-baseline, placebo lead-in study for the treatment of aggression and anxiety in six mentally retarded adult patients. The findings demonstrate buspirone's effectiveness in reducing aggression and anxiety in a mentally retarded group of subjects without causing deleterious cognitive side effects. The authors review a body of literature on animal and human subjects where buspirone was used in the treatment of aggression and other mental disorders. Unlike neurleptics and benzodiazepines, buspirone does not cause sedation which can compromise adaptive and intellectual capacities and thus reduce the patient's potential to benefit from training programs. Institutional address: Department of Medical Services Medfield State Hospital Mass 02052. (REFERENCE 10 OF 39) 91079136 Giakas WJ Seibyl JP Mazure CM Valproate in the treatment of temper outbursts [letter] J Clin Psychiatry 1990 Dec;51(12):525 [No Abstract Available] (REFERENCE 11 OF 39) 79109457 Lion JR Benzodiazepines in the treatment of aggressive patients. J Clin Psychiatry 1979 Feb;40(2):70-1 A double-blind, controlled clinical trial of chlordiazepoxide, oxazepam and placebo was conducted in 65 outpatients with past histories of temper outbursts, assaultive behavior and impulsiveness associated with anxiety, irritability and hostility. Of those tests showing statistically significant results, there was a tendency for oxazepam to be somewhat more effective in the reduction of anxiety than chlordiazepoxide. Oxazepam was also superior to the latter on 1 subscale of tests used to measure hostility. No paradoxical rage responses were noted. (REFERENCE 12 OF 39) 86168063 Simpson DM Foster D Improvement in organically disturbed behavior with trazodone treatment. J Clin Psychiatry 1986 Apr;47(4):191-3 Four elderly patients with severe organic brain syndromes and disurbed ehavior were treated with trazodone after therapy with neuroleptics had been ineffective.The behaviorof all four patients improved substantially. In each case, the clinical presentation did not suggest a depressive illness, and many of the disturbed behaviors, such as hypersexuality, are not generally considered characteristic of depression. The improvement in behavior may be related to the taming effect of trazodone in animal models of aggression. This effect is not shared by other antidepressants; thus, trazodone may have unique value as an alternative to neuroleptics for the treatment of organically disturbed behavior. *****JOURNAL OF NERVOUS AND MENTAL DISEASE***** (REFERENCE 13 OF 39) 75116032 Itil TM Wadud A Treatment of human aggression with major tranquilizers, antidepressants, and newer psychotropc drugs. J Nerv Ment Dis 1975 Feb;160(2-1):83-99 Most of the drugs used in the treatment of aggressive syndromes have originally been developed for other clinical applications. Despite significant differences in the pathogenesis of various aggressive disorders, the frequently used "antiaggression" drugs are the major tranquilizers (neuroleptics). If the aggresstion is associated with psychosis, chlorpromazine or haloperidol are the drugs of choice. Aggressive disorders within the acute and chronic brain syndromes are best treated with pericyazine, thioridazine, and thiothixene. In aggressive symptoms of mentally retarded patients, particularly with epileptic syndromes, a new benzazepine (SCH12,679)was found to be very effective. Aggression associated with alcoholism or narcotic addiction showed best response to chlorpormazine and haloperidol. As a general rule, in aggessive patients with clinically known epilepsy, or with abnormal electroencephalographic findings, the majr tranquilizers with potent sedative properties should be given with great caution. (REFERENCE 14 OF 39) 75116031 Lion JR Conceptual issues in the use of drugs for the treatment of aggression in man. J Nerv Ment Dis 1975 Feb;160(2-1):76-82 Violence is a symptom of an underlying mental state such as a psychosis, a characterological problem, or brain dysfunction. Thus drugs used to treat aggression in man exert effects by their specific pharmacological actions (e.g., antipsychotic, anticonvulsant). Most literature to date has dealt with animals and human models of aggression and lacks conceptual clarity. Aggression differs from depresion, a coherent clinical entity, in its etiological diversity and its paroxysmal or impulsive basis, and this may account for the relationship seen in literature linking violence to epilepsy; yet literature on anticonvulsants is equivocal with regard to beneficial effecs on aggression. Lithium has been shown to have positive effects, although its mode of action is unclear. A variety of antipsychotic agents and minor tranquilizers have been mentioned. Central nervous system stimulants hae been found useful to treat hyperkinetic syndromes in both children and adults where aggression is a symptom. Hormonal agents are discussed. Drug treatment of aggression should not obscure the need for verbal therapies, and social and environmental factors should always be regarded. (REFERENCE 15 OF 39) 75116027 Blumer D Migeon C Hormone and hormonal agents in the treatment of aggression. J Nerv Ment Dis 1975 Feb;160(2-1):127-37 Evidence for the role of androgens in the male aggressive and sexual behavior is reviewed. Medroxyprogesterone acetate (MPA; Provera, Upjohn) has a marked antiandrogen property; it is effective in lowering the testoerone level and controlling certain otherwise intractable sex deviations. The finding in 6 patients treated for sex deviation are summarized. The effects of MPA in the treatment of 11 temporal lobe epileptics and 5 other patients with severe angry- aggressiv behavior disorder are reported. Most temporal lobe epileptics responded well to MPA. Weight gain and earlier sleep were consistent side effects. The values of plasma testosterone, serum luteinizing hormone, and urinary 17-ketosteroids were decreased by the treatment. Four patients were XY individuals with lack of control over their sexual-aggressive or angry-aggressive impulses. (REFERENCE 16 OF 39) 75116026 Monroe RR Anticnvulsants in the treatment of aggression. J Nerv Ment Dis 1975 Feb;160(2-1):119-26 A significant number of violent acts are committed by individuals in whom central nervous system instability can be demonstrated by special electroencephalographic (EEG) activation procedures utilizing alpha-chloralose as the activaing agent. Furthermore, subcortical electrograms suggest that this instability is related to a circumscribed ictal phenomenon in the limbic system. The abruptness of thggressive act, the fact that the behavior is so often out of character for the individual and inappropriate for the situation, well as the confusion and partial amnesia which accompany these episodes lend clinical support for the ital hypothesis. Some anticonvulsants not only block the activated abnormalities on the EEG but also lead to dramatic clinical improvement in those individuals showing repeated and frequent aggressive behavior. For instance, in one study 46.7 percent and 53.3 per cent of the patients demonstrated activated abnormalities on no drug and placebo, respectively. When these same patients were receiving chlorpormazine or trifluoperazine, the activation rates were 60.0 per cent and 73.3 per cent, respectively.On the other hand, when these same patients re placed on a regimen of chlordiazepoxide the activation rate was reduced to 20 per cent (p smaller than or equal to .01). Anther study involved severely distrubed chronically hospitalized psychotic patients whose aggressive uncontrolled outbursts relegated then ot only to a locked ward, but often to isolation rooms despite high doses of phenothiazines A regimen of chlordiazepoxide and (REFERENCE 17 OF 39) 75116025 Sheard MH Lithium in the treatment of aggression. J Nerv Ment Dis 1975 Feb;160(2-1):108-18 Lithium has become a widely accepted treatment for manic-depressive psychosis. It is dramatically effective for many cases of mania and is useful in the prevention of manic and depressive episodes. Hyperaggressiveness and hypersexuality are frequent components of manic-depressive illness and abate under the influence of lithium. A brief reviw is presented of the behavioral and biochemical pharmacology of lithium. This documents the inhibitory role which lithium can playin several examples of animal aggressive behavior inclung pain-elicited aggression, mouse killing in rats, isolation- indced aggression in mice, p-chlorophenylalanine-induced aggression in rats, and hypothalamically induced aggression in cats. The use of lithium to control human aggressive behavior has resulted in controversial findings. In epileptic conditions, improvement has been reported in interseizure aggressivity, but other reports indicate the possibility of increased seizures. Improvement in aggressive behavior in childhood has occasionally been reported as well as in emotionally unstable character disorders in young female patients. Te was a single blind study and the other a large but uncontrolled study. Both studies reported an improvement in aggressiveness as indicated by fewer recorded reports (tickets) for fighting. The final stuy reported is a study of 12 male deinquents age 16 to 23. They received lithium or placebo for 4 months inside an institution and then a trial of lithium for 1 to 12 months on an outpatient basis. Analyis of results in terms of the number of aggressive antisocial acts showed fewer serious aggessive episodes when the lithium level was between 0.6 and 1 meq/liter than when it was between 0.0 and 0.6 meq/liter. These results must be viewed with caution and are only suggestive since the study was not double blind. (REFERENCE 18 OF 39) 75116024 Azcarat CL Minor tranquilizers in the treatment of aggression. J Nerv Ment Dis 1975 Feb;160(2-1):100-7 Clinical trials designed to evaluae the efficacy of drugs in human aggression have been scarce until recent years. The potential antiaggressive action of minor tranquilizers in humans has received little attention in spite of the claimed "taming effect" in some animal studies. A recent report examining the literature regarding the effects of benzodiazepines on animal models of aggressive behavior has pointed out the lack of consistency in such findings. Similar observations have been noted in humans where reduction in aggressive manifestations is contrasted with an increase in hoslity in a few sudies, as well as with the appearance of "paradoxical" rage reactions. Some variables that could account for such discrepancies have been advanced. They include, among others, dosage, acute vs. chronic drug administration, and possible qualitive differences among this group of agents. Individual variations as to presenting clinical picture, initial levels of anxiety and hostility, and personality types have also been mentioned. Implications of some of these findings for future clinical research are discussed. At present, a study designed to test the efficacy of two benzodiazepines, at dosages higher than those usually recommended, is being carrieout in a population of anxious, aggressive-prone individuals with poor impulse control. Thus far, and in agreement with our previous clinical experience, we have not seen "paradoxical" rage and such high dosges have been well tolerated. (REFERENCE 19 OF 39 86198692 Greendyke RM KanteDR Schuster DB Verstreate S Wootton J Propranolol treatment of assaultive patients with organic brain diseas. A double-blind crossover, placebo-controlled study. J Nerv Ment Dis 1986 May;174(5):290-4 A double-blind, placebo-controlled crossover study was conducted to examine the effects of long-acting propranolol in the treatment of violent behavior asociated with organic brain disease in 10 patients whose symptoms had proved refractory to various conventional medications. Long-acting propranolol treatment was associated with reductions of assaultive behavior without apparent sedative effects. Cautions are noted regarding potential undesirable side effects which may necessitate careful patient monitoring during treatment. (REFERENCE 20 OF 39) 85184685 Griffith JL Treatment of episodic behavioral disorders with rapidly absorbed benzodiazepines. J Nerv Ment Dis 1985 May;173(5):312-5 In selected patients with episodic behavioral disorders, rapidly absorbed benzodiazepines can be given orally to abort paroxysmal symptoms in their prodromal stages or to disrupt a cycle of continuous, serial symptoms. A case example illustrates each use. *****JAMA**** (REFERENCE 21 OF 39) 78197304 Fauman MA Treatment of the agitated patient with an organic brain disorder. JAMA 1978 Jul 28;240(4):380-2 Agitated patients with organic brain disorders represent relatively common diagnostic and management problems. Therapeutic failures usually result from a failure to understand the patient's disturbed behavior, the staff's emotional response to the patient's behavor, or neglect of the biological cause and ineffective use of medication. Effective management depends on continued monitoring of the patient's mental status and physical condition. *****LANCET***** (REFERENCE 22 OF 39) 82218560 Hakola HP Laulumaa VA Carbamazepine in treatment of violent schizophrenics [letter] Lancet 1982 Jun 12;1(8285):1358 [No Abstract Available] *****NEW YORK STATE JOURNAL OF MEDICINE***** (REFERENCE 23 OF 39) 71231107 Frenkel RE Clinical management and treatment of rage. N Y State J Med 1971 Jul 15;71(14):1740-3 [No Abstract Available] *** *** *****ACTA PAEDIATRICA HUNGARICA***** (REFERENCE 24 OF 39) 90057111 Somogyi I Vetro A Szentistvanyi I Szekely J Szilard J Lithium treatment of aggressive children and the EEG. cta Paediatr Hung 1988-89;29(3-4):365-72 Electroencephalograms (EEG-s) of 44 children aged 6.3--15.4 years were examined at the baseline and 3 months laer with two different doses of lithium. Lithium levels in serum in group I. ranged from 0.08 mmol/l to 0.33 mmol/l (mean: 0.23 mmol/l SD: 0.105), and in group II. ranged from 0.40 mmol/l to 0.84 mmol/l (mean: 0.555 mmol/l SD: 0.116). These children represent as Conduct Disorr. EEG-s were correlated across treatment groups with behavioural ratings, ratings of untoward effects, reaction time and different dosages of medication. In the group I. alpha-recovery time after-eye closing and percentage time of alpha activity in 60 s decreased at unchanged mean alpha frequency. In the group II. both alpha recovery time and alpha activity increased at unchanged mean alpha frequency. Paroxysmal focal abnormalities (spikes, spike-waves etc.) or increase in percentage time of delta activity were not found. Behavioural changes were assessed by using the Pictures Frustration Test for Children of Rosenzweig and the Hamburg Personality Inventory for Children. The group II. were found to be significantly superior to group I. in decreasing aggressive symptoms. No serious differences were found for the reaction time and side effects as well. Institutional address Department of Neurology and Psychiatry University Medical School Szeged Hungary. *****ACTA PSYIATRICA SCANDINAVICA***** (REFERENCE 25 OF 39) 89319728 George DT Anderson P Nutt DJ Linnoila M Aggressive thoughts and behavior: another symptom of panic disorder? Acta Psychiatr Scand 1989 May;79(5):500-2 We repot on 3 individuals who describe aggressive thoughts and behaviors that frequently occurred in association with panic symptoms. It is theorized that the seemingly paradoxical emotions of fear and aggression may actually share a similar etiology. Of clinical interest, the subjects improved in both their panic and aggressive symptoms when they were treated with antidepressant edication. Institutional address: National Institute on Alcohol Abuse and Alcoholism Bethesda Maryland. (REFERENCE 26 OF 39) 89131783 Yatham LN McHale PA Carbamazepine in the treatment of aggression: a case report and a review of the literature. Acta Psychiatr Scand 1988 Aug;78(2):188-90 Aggressive behaviour is an inescapable clinical problem confronting practitioners f medicine, neurology and psychiatry. Sveral drugs have been used to treat it, with limited success. Successful use of carbamazepine in the treatment of aggressive behaviour in a patient with limbic dysfunction is reported, and varieties of aggressive behaviour that respond to carbamazepine are examined. The authors suggest that carbamazepine may have a specific anti-aggressive effect perhaps due to an anti-kindling effect, but caution that double-blind studies are needed before firm conclusions are drawn. Institutional address: St. Ita's Hospital Portrane Co. Dublin Republic of Ireland. *****AMERICAN JOURNAL OF ORTHOPSYCHIATRY***** (REFERENCE 27 OF 39) 8612632 Chethik M Levels of borderline functioning in children: etiological and treatment considerations. Am J Orthopsychiatry 1986 Jan;56(1):109-19 It has been noted frequently in the literature that the term "borderline pathology" denotes a range of disturbances. While borderline patients are characterized by severe object relations problems, there is an extremely wide range of ego functioning in these patients. Stemming from work with borderline children, this paper describes this range of varied functioning and develops inferences, based on clinical material, regarding the etiology of these differences. *****APPLIED RESEARCH IN MENTAL RETARDATIO***** (REFERENCE 28 OF 39) 86185458 Matson JL Gorman-Smith D A review of treatment research for aggressive and disruptive behavior in the mentally retarded. Appl Res Ment Retard 1986;7(1):95-103 This study reviews current treatment research on aggression of mentally retarded persons. Twenty-seven stuies meet methodological criteria from an initial pool of 47. All the studies reviewed were empirical and had been published in national and internationally recognized journals. Treatments were behavioral and level of mental retardation and ages of the persons studied varied widely. Age and level of mental retardation proved to be significant factors in predicting treatment outcome. Also, it was found that some types of behaviors were treated more frequently than others, with inappropriate verbal responses being the most common, followed by aggression toward others and noncompliance. The implications of these findings are discussed. *****AUSTRALIAN AND NEW ZEALAND JOURNAL OF PSYCHIATRY***** (REFERENCE 29 OF 39) 78235206 Kiloh LG Smith JS The neural basis of aggression and its treatment by psychosurgery. Aust N Z J Psychiatry 1978 Mar;12(1):21-8 The limbic system and its connections provide the neural basis for aggressive behaviour. Violent individuals may differ quantitively r qualitively from normal. Many of the latter suffer from epilepsy. In some the epileptifor discharges frm the amygdala can only be recorded using depth electrodes. It can be taken that the control of abnormal degrees of violent behaviour is now possible. Should such operations be used? If so who should have them? What preacutions need to be taken that such operations are not abused? How can informed consent be obtained? The development of new surgical techniques make these questions pertinent if not urgent. *****BEHAVIOURRESEARCH AND THERAPY***** (REFERENCE 30 OF 39) 86295450 Deffenbacher JL Demm PM Brandon AD High general anger: correlates and treatment. Behav Res Ther 1986;24(4):481-9 [No Abstract Available] *****BIOLOGICAL PSYCHIATRY***** (REFERENCE 31 OF 39) 91055054 Volavka J Crowner M Brizer D Convit A Van Praag H Suckow RF Tryptophan treatment of aggressive psychiatric inpatients. Biol Psychiatry 1990 Oct 15;28(8):728-32 This double-blind, placebo-controlled study tested the effectiveness of tryptophan (TRP) in the treatment of aggressive psychiatric inpatients. After a baseline observation period of 1 month, patients were randomly assigned to treatment either with TRP (up to 6 g/day) or with placebo. There were 10 subjects in each treatent group. These treatments were administered for 25-35 days, afte which the patients were observed for 1 month. Throughout this study, patients were receiving other medications. Injections of antipsychotics and sedatives were administeredas needed to control agitated or violent behavior. Blood levels of TRP and other large neutral amino acids were obtained repeatedly, and ratios between TRP and other amino acids were computed. These analyses confirmed significant increases of TRP ratios in TRP-treated patients. TRP treatment had no effect on the number of violent incidents, but it significantly reduced the need for injections of antipsychotics and sedatves. The stud thus provided indirect support for beneficial effects of TRP in aggressive psychiatric inpatients. Institutional address: Nathan S. Kline Institute for Psychiatric Research Orangeburg New York 10962. *****JOURNAL OF CLINICAL PHARMACOLOGY***** (REFERENCE 32 OF 39) 83031335 Feldman HS Loxapine succinate as initial treatment of hostile and aggressive schizophrenic criminal offenders. J Clin Pharmacol 1982 Aug-Sep;22(8-9):366-70 The efficacy and safety of loxapine were evaluated in 18 acutely ill schizophrenic criminal offenders in the Essex County Jail. The offender patients were treated for three days with intramuscular loxapine (25 mg three or four times a day), followed by seven days of oral concentrate (up to 150 mg/day in three or four divided doses). Psychiatric status was determined with the Brief Psychiatric Rating and the Clinical Global impression scales at the time of admission, after 8, 24, 48, and 72 hours, amd on days 7 and 10 of medication. Three patients did not complete treatment: one was released on bail after 24 hours of therapy, and the othertwo had adverse reactions (tongue swelling and muscle spasms, each in one patient) which required cessation of treatment. Statistically significant improvement in both rating scale results was evident as early as 8 hours after treatment began. By day 10, all Brief Psychiatric Rating Scale items and factors and the Clinical Global impression results were statistically improved over baseline measurements. At the end of the study, 87 per cent (13/15) of the patients were well enough to cooperate with their attorneys and understand the procedures of the court. Adverse effects (generally extrapyramidal) appeared in four of 18 patients during parenteral administration and in two of 15 patients during oral therapy. *****JOURNAL OF GERIATRIC PSYCHIATRY AND NEUROLOGY***** (REFERENCE 33 OF 39) 89302521 Patterson JF A preliminary study of carbamazepine in the treatment of assaultive patients with dementia. J Geriatr Psychiatry Neurol 1988 Jan;1(1):21-3 Carbamazepine was administered in an open pilot study to 13 patients with primary degenerative dementia caracterized by aggressive and assaultive behavior refractory to conventional treatment. Tentatively, from this preliminary study, carbamazepine appears to have advantages in the treatment of assaultive patients with dementia. Institutional address: Psychiatry Service Harry S. Truman Memorial VA Hospital Columbia MO 65201. *****JOURNAL OF NEURAL TRANSMISSION***** (REFERENC 34 OF 39) 82077099 Maj J Mogilnicka E Klimek V Kordecka-Magiera A Chronic treatment with antideressants: protentiation of clonidine- induced aggression in mice via noradrenergic mechanism. J Neural Transm 1981;52(3):189-97 The chronic (10 mg/kg i.p. twice daily, 10 days)-and not the acute- administration of amitriptyline, maprotiline or zimelidine enhances aggressiveness induced by clonidine in mice. An analogous potentiation ofclonidine-induced aggressiveness was obtained with chronic administration (the schedule as above) of levomeprmazie (2 mg/kg) or thioridazine (5 mg/kg) but not of spiperone (0.2 mg/kg). Fluoxetine (10 mg/kg), atropine (5 mg/kg), propranolol (10 mg/kg) or metergoline (0.5 mg/kg) given chronically (the schedule as above) alsod no effect. The enhancement of clonidine aggessiveness induced by prolongedtreatment with imipramin (10 mg/kg) was prevented by cycloheximide, an inhibitor of protein synthesis. The results supply further evidence for the previously proposed hypothesis that chronic administration of antidepressants enhances the responsiveness of central postsynaptic noradrenaline receptors. *****PHARMACOLOGY, BIOCHEMISTRY AND BEHAVIOR***** (REFERENCE 35 OF 39) 81199711 Willner P Theodorou A Montgomery A Subchronic treatment with the tricyclic antidepressant DMI increases isolation-induced fighting in rats. Pharmacol Biochem Beh 1981 Apr;14(4):475-9 Male rats treated wth desmethylimipramine (DMI) (20 mg/kg for 7 days) were more likely than controls to attack an intruder rat placed in their home cage; they were also more likly to submit when attacked by the intruder. These behavioural changes were not seen at lower doses of DMI. Similar results were obtained in experiments in which is drugged animal and a control were placed together in a "neutral" cage; in this pradigm it ws also found that lower doses of DMI were effective, provided that either the period of ug treatment was increased, or a delay of 3-4 days after withdrawal of DMI preceded behavioural testing. A dose dependent resistance to handling developed during drug treatment; drugged animals also showed weight loss and decreased open-field activity. In previous studies, acute treatment with tricyclic antidepressants has not been found to increase fighting; the present results underline the importance of chronic drug studies. (REFERENCE 36 OF 39) 81151185 Mogilnicka E Przewlocka B Facilitated shock-induced aggression after chronic treatment with antidepressant drugs in th rat. Pharmacol Biochem Behav 1981 Feb;14(2):129-32 The effects of four antidepressant drugs with different mechanisms of action on shock-induced fighting between pairs of rats were determined. Amitriptyline, imipramine, mianserin and iprindole, given chronically, facilitated figting behavior. (REFERENCE 37 OF 39) 75196829 Harrell LE Balagura S Septal rage: mitigation by pre-surgical treatment with p- chlorophenylalamine. Pharmacol Biochem Behav 1975 Mar-Apr;3(2):157-9 Destruction of the septum leads to a well known hyperirritability syndrome. However, the intensity of this syndrome is modifiable by certainpresurgical teatments. Injections, prior to surgery of para- chlorophenylalanine (PCPA) for two days or insulin for five days has no effect on septal rage. However, injections of PCPA five days prior to surgery leads to a marked reduction in septal hyperirritability. *****POLISH JOURNAL OF PHARMACOLOGY AND PHARMACY***** (REFERENCE 38 OF 39) 84297809 Maj J Central effects following repeated treatment with antidepressant drugs. Pol J Pharmacol Pharm 1984 Mar-Jun6(2-3):87-99 The review sums up the results of experiments in which there were studied central effects following repeated administration of various antidepressant drugs (AD) in rats and mice. A number of typical and atypical AD, except for selective inhibitors of 5-hydroxytryptamine (5-HT) uptake, potentiate the clonidine aggressiveness in mice (medicated by alpha 1-adrenoctors). These results indicate that the repeated AD administration enhances responsiveness of central postsynaptic alpha 1-anoceptors. This assumption is in accordance with electrophysiological literature data. A few AD (including citalopram, a selective inhibitor of the 5-HT uptake), administered repeatedly, potentiate the locomotor hyperactivity induced by D- amphetamine or apomorphine, without affecting the stereoypy evoked by both dopaminomimetics. It may be supposed that A enhance the responsiveness of a dopamine (DA) system, probably the mesolimbic one (but not the striatal one). A repeated administration of various AD also counteracts the locomotor hypoactivity induced by salbutamol (mediated by a beta-adrenoceptor). The importance of the effects stated above (alpha 1 up-regulation, DA up-regulation, beta down- regulation) for the mechanism of antidepressant action has been discussed. *****PSYCHOLOGICAL REPORTS***** (REFERENCE 39 OF 39) 82275722 Warren R McLellarn RW Systematic desensitization as a treatment for maladaptive anger and aggression: a review. Psychol Rep 1982 Jun;50(3 Pt 2):1095-102 [No Abstract Available]