The use of anticonvulsants in aggression and violence

Aggression and violence are not univariate concepts. A key to research into the effects of anticonvulsants on aggression and violence is using a nosology that provides a theoretical basis for the clinical use of anticonvulsants and leads to meaningful criterion measures for their evaluation. It is proposed that aggression can be divided into three broad categories: (1) medically related--the aggression is a symptom secondary to a psychiatric, neurological, or other medical disorder; (2) premeditated or planned--the aggressive act is an instrumental response; (3) impulsive--this is a hair-trigger response, that is, the subject does not process information in an adaptive way during the temper outburst. It is hypothesized that selected anticonvulsants (e.g., phenytoin and carbamazepine) will have a therapeutic effect on impulsive aggression. Preliminary data from our research indicate that phenytoin does decrease impulsive aggressive acts. Possible pharmacodynamic mechanisms for these results are briefly discussed within the context of electrophysiological measures at different levels of the central nervous system (event-related potentials, kindling, and ion channel functions). It is further proposed that the equivocal findings in the early studies of the effects of phenytoin on aggression were due to poor criterion measures and inappropriate inclusion/exclusion criteria for subjects (especially failure to document psychiatric or neurological disorders). The early results of our research on carbamazepine are encouraging, but not enough data have been gathered to document its effects on impulsive aggression. The therapeutic use of anticonvulsants to control aggressive and violent behaviors has a long and controversial history (Monroe 1975).(ABSTRACT TRUNCATED AT 250 WORDS)