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Antipsychotics for aggression in adults: A meta-analysis.

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Antipsychotic medications effectively treat aggression in adults, with effect sizes comparable to non-pharmacologic methods. Clinical decisions should consider their modest impact versus potential side effects.

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Area of Science:

  • Psychiatry
  • Pharmacology
  • Behavioral Science

Background:

  • Aggressive behavior is a common and debilitating symptom in various psychiatric conditions.
  • Antipsychotic medications are frequently prescribed to manage aggression across diagnoses.

Purpose of the Study:

  • To determine the effect size of antipsychotic medications for treating reactive-impulsive aggression in adults.
  • To explore variations in effectiveness based on the underlying psychiatric diagnosis and specific antipsychotic agent used.

Main Methods:

  • A comprehensive literature search was conducted across four major databases (MEDLINE, PsychINFO, Embase, Cochrane Library) up to August 2016.
  • Included studies focused on aggression, irritable mood, anger, hostility, and antipsychotic agents or dopamine antagonists.
  • A meta-analysis synthesized data from 21 selected studies.

Main Results:

  • Antipsychotics demonstrated broad effectiveness in treating aggression, with a standard mean difference of 0.29 (95% CI 0.22-0.36).
  • Effect sizes were similar to non-pharmacologic interventions.
  • No significant differences in efficacy were found based on the specific antipsychotic agent or conclusive evidence for diagnostic differences. A small, significant dose-effect relationship was observed.

Conclusions:

  • Antipsychotics are broadly effective for aggression but offer modest effect sizes.
  • The choice of agent or underlying diagnosis did not significantly alter effectiveness.
  • Clinical decisions should weigh the moderate benefits against the potential for significant side effects.