[Lithium and aggression in adults]

The use of lithium as an antiaggressive agent independently of its action in bipolar illness is now well documented. It appears particularly effective in the control of aggressive behavior in chronically aggressive prisoners and mentally retarded patients. Approximately 70-75% of these patients are likely to show a positive response to lithium therapy. No convincing features have been identified as being predictive of a good response. The clinical effect of lithium is to reduce the frequency and the severity of both hetero and auto aggressive outbursts. The use of lithium for aggressive behavior remains controversial in epileptic disorders and inconclusive in chronically psychotic patients. Careful monitoring of lithium blood levels is necessary to ensure adequate therapeutic efficacy without toxicity. A caution is needed in patients with brain damage especially when concurrent neuroleptic treatment is used. The antiaggressive effect of lithium seems rather specific and may be associated with a serotoninergic effect.