Lithium in the Treatment of Aggression in Mentally Handicapped Patients

Craft, Michael; Ismail, Ismail A.; Krishnamurti, D; Mathews, Jose; Regan, A.; Seth, Ram; North, Philip M.

doi:10.1192/bjp.150.5.685

Cited by 105 publications

(32 citation statements)

References 16 publications

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“…Mood stabilizers lithium Oral 2 [28,29] Two randomized inpatient trials, one industry sponsored [29] (Regan, personal communication), the other not [28] Both trials had a placebo run-in before randomization but showed benefit with lithium treatment Benzodiazepines Oral/ injectable 1 [17] Clinical opinion only Widely used, without good evidence Anger management Group 2 [30,31] Two randomized trials Both trials are encouraging and have led to a large, funded, randomized trial with Prof. P. Willner as principal investigator (HTA 08/53/34, UKCRN ID 7089 [32] )…”

Section: Antipsychotic Drugsmentioning

confidence: 96%

Aggressive Behaviour in Adults with Intellectual Disability

2009

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A complex form of aggression, commonly expanded as 'aggressive challenging behaviour', is reported in one in four adults with intellectual disability and is often treated with antipsychotics, mood stabilizers and antidepressants. Psychological treatments, including anger and behavioural management, person-centred planning and manipulation of the environment (nidotherapy), have also been used when available but to a lesser extent. In this article, the evidence for efficacy for each intervention is examined, with data from randomized controlled trials given primacy. Very little evidence, based on limited data, can be found for the interventions of anger and behavioural management and also for the atypical antipsychotic drug, risperidone; the data available on these interventions come primarily from studies conducted in children in whom the behaviour is part of the autistic spectrum. Antipsychotic drugs, particularly the atypical group, have been the most commonly used interventions in recent years, but a recent independent randomized trial showed no benefits for either risperidone or haloperidol compared with placebo, with some evidence of a better response to placebo than either active drug in the reduction of aggression. In the light of this uncertainty, the clinician must return to the task of collecting a careful history and mental state examination, including awareness of the setting in which the behaviour is shown, which will help with diagnosis and appropriate intervention. The choice of intervention should not be a casual one and is not likely to be chosen well if the clinician relies only on standard guidelines. The paucity of randomized trial evidence is preventing progress in the treatment of persistent aggressive behaviour. On present evidence, the use of drug treatment should be much more sparing and reserved for those patients who are putting themselves and others at particular risk as a consequence of their behaviour; such treatment should be regarded as temporary and as adjunctive to other forms of management. There is an urgent need for larger, randomized studies of psychological interventions, which at present appear to have a higher benefit-risk ratio than drug treatment but that also have a poor evidence base. More care should be taken to avoid the term 'aggressive challenging behaviour' being used as a portmanteau diagnostic pseudonym when it merely represents a diverse oppositional repertoire of many aetiologies.

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Section: Antipsychotic Drugsmentioning

confidence: 96%

Aggressive Behaviour in Adults with Intellectual Disability

2009

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“…Lithium is used in the management of mania, bipolar disease, and aggression associated with personality disorders [139] and intellectual disabilities [140]. Its primary action is to alter sodium transport and increase intracellular metabolism of catecholamines.…”

Section: Lithiummentioning

confidence: 99%

Pharmacological management of neurobehavioral disorders following traumatic brain injuryA state-of the-art review

Chew

Zafonte²

2009

JRRD

161

103

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Abstract-Pharmacological management of neurobehavioral disorders following traumatic brain injury (TBI) is common practice. However, the evidence available to guide this practice remains sparse. This review summarizes, in brief, the state of knowledge, organized via a time continuum from injury as well as by symptom complex. The areas of neuroprotection, hypoarousal, attention and memory deficits, aggression, agitation, depression, and mania are reviewed. The literature was searched with PubMed on the terms "traumatic brain injury" or "brain injury" with "pharmacology" (and the symptoms according to which this review is arranged). Additional searches were conducted with the specific symptoms as search terms, crossed with the therapeutic agents or drug classes discussed. Where a paucity of prospective data exists, case reports and retrospective studies are included. Studies to date have yielded minimal positive evidence for enhancing function, memory, and behavior after TBI. No single agent likely will become sentinel in the recovery process, and combination therapy in the acute and postacute settings are required. A need exists to further define the role of psychopharmacology in postacute TBI medicine and the specific characteristics of subpopulations who might benefit.

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“…Lithium was added to existing medication regimens in order to target aggression. Seventy-three percent improved and 9% got worse when treated with lithium carbonate compared to 30% improved with placebo [85]. A second study had a double blind, controlled crossover design with N = 52.…”

Section: Lithium Carbonatementioning

confidence: 97%

Diagnosis and Treatment of Aggression in Individuals with Developmental Disabilities

2008

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Aggressive behavior is a common referral problem for individuals with developmental disabilities (DD), placing them at risk for institutionalization, social isolation, physical restraint, over-use of medication to treat behavior problems, exclusion from services, and becoming a victim of abuse. Aggression strains relationships between individuals being supported and their caregivers, whether professionals or family members. The treatment of aggression is persons with DD, with or without comorbid mental illness, remains a controversial area and changes in practice have been slow to come. The evidence related to pharmacotherapy and psychological treatment is, in general, either lacking or poor. This does not suggest that these treatments are necessarily ineffective but that there is not enough good quality evidence to support their usefulness. This review considers the prevalence and correlates of aggression, as well as possible causative factors. The relationship between mental illness, intellectual disability and aggression is explored. The psychopharmacological and psychological treatment literature is reviewed with implications for clinical care and future research.

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Lithium in the Treatment of Aggression in Mentally Handicapped Patients

Cited by 105 publications

References 16 publications

Aggressive Behaviour in Adults with Intellectual Disability

Aggressive Behaviour in Adults with Intellectual Disability

Pharmacological management of neurobehavioral disorders following traumatic brain injuryA state-of the-art review

Diagnosis and Treatment of Aggression in Individuals with Developmental Disabilities

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