Question: In adults with impulsive aggressive behaviour (intermittent explosive disorder or episodic dyscontrol syndrome) how effective are pharmacological interventions, compared to any other intervention, in improving patient outcomes?

Answer:

 Plain language summary

No firm conclusions can be made from the available evidence, only two articles were found which found fluoxetine to be effective compared to placebo and no significant findings for the use of mood stabilisers. The need for further research into the use of pharmacological interventions impulsive aggressive behaviour was identified.

Clinical and research implications

No definite clinical implications may be made based on the evidence presented in this BEST summary. In one of the included papers, there was evidence of the effectiveness of fluoxetine compared with placebo, but the authors stated that "fluoxetine should not be considered a 'magic bullet' for the treatment of impulsive aggression in intermittent explosive disorder (IED)" and that "other agents and modalities will be needed for the successful treatment of most individuals with IED or with problematic histories of impulsive aggression." It was also suggested that further studies are needed to replicate the fluoxetine study. A SR that evaluated mood stabilisers did not recommend any particular evidence, and highlighted the need for further well-conducted RCTs to investigate different mood stabilisers for the treatment of aggression.

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