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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