The neurobiology of aggression: implications for the pharmacotherapy of aggressive challenging behaviour by people with intellectual disabilities

Willner, Paul

doi:10.1111/jir.12120

Cited by 32 publications

(25 citation statements)

References 83 publications

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Section: Discussionmentioning

confidence: 66%

“…In the presence of aggression/destruction, the relative risk of using hypnotics/sedatives was over 200% and 700% for using antiepileptics as mood stabilisers. Mood stabilisers for aggression have been documented in other studies (Deb et al 2014;Wilner 2014: Tsiouris et al 2015. Overall, our data indicate that differences in prescribing patterns may be associated with specific challenging behaviours, or the features associated with those behaviours which requires further investigation.…”

Section: Discussionmentioning

confidence: 72%

“…Sheehan et al () reported that 47% of participants with a record of challenging behaviour received antipsychotics but only 12% had a record of mental illness. There remains no convincing evidence of positive treatment effects of these medications on challenging behaviour (Emerson and Baines ; Tsiouris ; Paton et al ; Wilner ). The underlying aetiological factors for challenging behaviour are complex and varied (Hastings et al ) so treatment with medication alone is unlikely to resolve the issue.…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of psychotropic medication use and association with challenging behaviour in adults with an intellectual disability. A total population study

Bowring

Totsika

Hastings

et al. 2017

J intellect Disabil Res

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Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 72%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Prevalence of psychotropic medication use and association with challenging behaviour in adults with an intellectual disability. A total population study

Bowring

Totsika

Hastings

et al. 2017

J intellect Disabil Res

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“…Some biomarkers are “surrogate endpoints” which substitute clinical endpoints that reflect “how a patient feels, functions, or survives” [Atkinson et al, ]. There are several comprehensive overviews of biochemical compounds as potential biomarkers for aggression [e.g., Siever, ; Yanowitch and Coccaro, ], including reviews of neurotransmitters [e.g., de Almeida et al, ; Seo et al, ; Siever, ; Wallner and Machatschke, ; Chichinadze et al, ; Yanowitch and Coccaro, ; Haller, ; Umukoro et al, ; Morrison and Melloni, ; Narvaes and Almeida, ; Willner, ], hormonal networks [Simpson and Hons, ; Wingfield et al, ; Siever, ; Soma et al, ; Chichinadze et al, ; Eisenegger et al, ; Haller, ,; Soma et al, ], and cytokines [e.g., Zalcman and Siegel, ]. With a few exceptions [e.g., Siever, ], these reviews focus on a single biochemical class, studying biomarkers belonging to various different biochemical pathways in isolation.…”

Section: Introductionmentioning

confidence: 99%

Discovery of biochemical biomarkers for aggression: A role for metabolomics in psychiatry

Hagenbeek

Kluft

Hankemeier

et al. 2016

American J of Med Genetics Pt B

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Human aggression encompasses a wide range of behaviors and is related to many psychiatric disorders. We introduce the different classification systems of aggression and related disorders as a basis for discussing biochemical biomarkers and then present an overview of studies in humans (published between 1990 and 2015) that reported statistically significant associations of biochemical biomarkers with aggression, DSM-IV disorders involving aggression, and their subtypes. The markers are of different types, including inflammation markers, neurotransmitters, lipoproteins, and hormones from various classes. Most studies focused on only a limited portfolio of biomarkers, frequently a specific class only. When integrating the data, it is clear that compounds from several biological pathways have been found to be associated with aggressive behavior, indicating complexity and the need for a broad approach. In the second part of the paper, using examples from the aggression literature and psychiatric metabolomics studies, we argue that a better understanding of aggression would benefit from a more holistic approach such as provided by metabolomics. Key words: aggression; biomarkers; psychiatry; metabolomics INTRODUCTIONArguably, "violence and aggression are the most serious problems facing humanity" [Chichinadze et al., 2011]. One approach in the study of aggression and its etiology is at a biochemical level.Biochemical markers are intermediate to the outward phenotype and the underlying biology of aggression. They can aid in elucidating the causes and (patho) physiology of aggressive behavior [James et al., 2006;Scoriels et al., 2015]. One of the promises of 719Neuropsychiatric Genetics biochemical studies of central nervous system diseases is the development of biochemically based biomarkers [KaddurahDaouk and Krishnan, 2009]. Biomarkers can be applied in diagnosis, in assessment of disease stages, as indicators of disease prognosis, and for prediction or monitoring of interventions and treatment responses. Some biomarkers are "surrogate endpoints" which substitute clinical endpoints that reflect "how a patient feels, functions, or survives" [Atkinson et al., 2001]. There are several comprehensive overviews of biochemical compounds as potential biomarkers for aggression [e.g., Siever, 2008;Yanowitch and Coccaro, 2011], including reviews of neurotransmitters [e.g., de Almeida et al., 2005;Seo et al., 2008;Siever, 2008;Wallner and Machatschke, 2009;Chichinadze et al., 2011;Yanowitch and Coccaro, 2011;Haller, 2013;Umukoro et al., 2013;Morrison and Melloni, 2014;Narvaes and Almeida, 2014;Willner, 2015], hormonal networks [Simpson and Hons, 2001;Wingfield et al., 2006;Siever, 2008;Soma et al., 2008;Chichinadze et al., 2011;Eisenegger et al., 2011; Haller, 2014a,c;Soma et al., 2015], and cytokines [e.g., Zalcman and Siegel, 2006]. With a few exceptions [e.g., Siever, 2008], these reviews focus on a single biochemical class, studying biomarkers belonging to various different biochemical pathways in isolation. This makes it...

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“…Causes of human aggression have been described in the literature according to various social psychological [3], neurobiological [4–10] and behavioral [11–15] models. Aggression is a frequently reported consequence of brain injury [16–20], and aggression can be divided into verbal or physical subtypes [16].…”

Section: Introductionmentioning

confidence: 99%

The relational neurobehavioral approach: can a non-aversive program manage adults with brain injury-related aggression without seclusion/restraint?

Kalapatapu

Giles

2016

Disability and Rehabilitation

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Purpose The Relational Neurobehavioral Approach (RNA) is a set of non-aversive intervention methods to manage individuals with brain injury-related aggression. New data on interventions used in the RNA and on how the RNA interventions can be used with patients with acquired brain injury (ABI) who have differing levels of functional impairment are provided in this paper. Method The study was conducted over a 6-week period in a secure 65-bed program for individuals with ABI that is housed in two units of a skilled nursing facility (SNF). Implementation of the RNA was compared between two units that housed patients with differing levels of functional impairment (n = 65 adults). Since this was a hierarchical clustered dataset, Generalized Estimating Equations regression was used in the analyses. Results RNA interventions used to manage the 495 aggressive incidents included: Aggression ignored, Closer observation, Talking to patient, Reassurance, Physical distraction, Isolation without seclusion, Immediate medication by mouth, Holding patient. Different interventions were implemented differentially by staff based on level of functional impairment and without use of seclusion or mechanical restraint. Conclusions The RNA can be used to non-aversively manage aggression in patients with brain injury and with differing levels of functional impairment. Programs adopting the RNA can potentially manage brain injury-related aggression without seclusion or mechanical restraint.

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The neurobiology of aggression: implications for the pharmacotherapy of aggressive challenging behaviour by people with intellectual disabilities

Abstract: With the possible exception of risperidone, there is no reliable evidence that antidepressant, neuroleptic or anticonvulsant drugs are effective treatments for aggression by people with ID.

Cited by 32 publications

References 83 publications

Prevalence of psychotropic medication use and association with challenging behaviour in adults with an intellectual disability. A total population study

Prevalence of psychotropic medication use and association with challenging behaviour in adults with an intellectual disability. A total population study

Discovery of biochemical biomarkers for aggression: A role for metabolomics in psychiatry

The relational neurobehavioral approach: can a non-aversive program manage adults with brain injury-related aggression without seclusion/restraint?

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