Beta Adrenergic Blocking Medications for Treatment of Rage Outbursts in Mentally Retarded Persons

Rage, defined as a "blindly furious impulse to violence and destruction," commonly occurs in retarded persons, either as an isolated symptom or as part of a psychiatric illness. Rage is distinguished from other forms of aggression by several characteristics, including the presence of central nervous system (CNS) dysfunction, as well as its episodic, explosive, and ego-dystonic nature. beta-adrenergic blocking medications have reported efficacy in the treatment of rage outbursts in a number of case reports, retrospective nonblind reviews, and several small double-blind, placebo-controlled studies. Mechanism of action may involve central CNS effects (receptor blockade, neurotransmitter agonist activity or membrane stabilization) and/or peripheral effects (attenuation of chronic sympathetic over-arousal). Effective doses are generally higher than those used for cardiac or vascular illness; response may not occur for 8 weeks or more after initiation of treatment. Contraindications and side effects are discussed. beta-blockers may be of particular benefit in developmentally disabled patients who are over-aroused, and whose rage is impulsive and explosive.