Supervisors info:
Δουζένης Αθανάσιος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Μιχόπουλος Ιωάννης, Αναπληρωτής, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Φερεντίνος Παναγιώτης, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Summary:
Introduction: Violence and aggression are major social problems and often affect patients with psychiatric disorders. Aggression in addition to physical and material damage can also cause mental injury. As a consequence of human aggression can be serious social, legal, emotional and financial problems.
The causes of aggressive behavior are complex and multifactorial. Social and cultural factors play an important role in the development of aggressive behavior, however the neurobiological background interacts with environmental factors.
Dopamine and serotonin receptors in the brain have been shown to be central to the regulatory mechanism of aggression. Decades of research have demonstrated the essential role of the medial hypothalamus and the median dopaminergic system in regulating aggressive behavior. Antipsychotics are very effective in treating violent behavior, and this is evident from their general use.
Typical antipsychotics have been shown to be effective in treating aggression, especially haloperidol. However, given the high risk of extrapyramidal side effects of first generation antipsychotics and the superior efficacy of atypical ones, atypical antipsychotics are particularly preferred in clinical practice.
Purpose of the meta-analysis: The purpose of this review was to investigate the effectiveness of second generation antipsychotics in dealing with violent behavior and aggression manifested in psychotic disorders, compared to typical antipsychotics.
In the present meta-analysis the selected studies examined the effectiveness of a second generation antipsychotic compared to a typical antipsychotic in the treatment of aggressive behavior.
Methods: This meta-analysis covers the last six years, specifically from February 2014 to March 2020. The bibliography was searched in the following databases: Pubmed, Scopus and Cochrane.
In the present meta-analysis, the selected studies were randomized controlled or open label studies in an adult population. They also looked at the effectiveness of a second-generation antipsychotic compared to a typical antipsychotic in treating aggressive behavior in psychotic disorders. All studies involving children, adolescents, the elderly, and any other mental disorders other than schizophrenia were excluded. Substance-induced psychiatric or substance abuse disorders were not included in the meta-analysis unless they involved schizophrenic disorder and met all other inclusion criteria. Dementia, genetic diseases, neuropsychiatric syndromes, mental retardation and neurodevelopmental disorders were also ruled out. In the studies included in the meta-analysis, the results in terms of changes in the intensity of aggression, hostility and irritability were measured with the PANSS scale and its sub-scale PANSS-EC (Positive and Negative Syndrome Scale-Excited Component).
All studies that met the above criteria from the databases mentioned were included.
Patients' scores on the PANSS or PANSS-EC scale prior to medication were measured, as well as the standard deviation of this value (SD) and the score on the PANSS or PANSS-EC scale after administration of the medication drugs, both typical and atypical antipsychotics, as well as its standard deviation.
Hung-Yu Chan et al (2014) studied the efficacy and safety of olanzapine IM in relation to the administration of haloperidol IM in patients with schizophrenia and acute behavioral disorders.
Charles Lung-Cheng Huang et al (2015) conducted a study comparing efficacy and safety profile between intramuscular olanzapine and IM haloperidol plus IM lorazepam in patients with moderate to severe schizophrenia.
Viroj Verachai et al (2014) compared the antipsychotic properties and side effects of quetiapine with haloperidol in people with methamphetamine-induced psychosis.
Results: This meta-analysis found that there was no difference in efficacy between typical and atypical antipsychotics.
Conclusion: From this meta-analysis it emerged that antipsychotics are widely effective in treating the stimulating and aggressive behaviors manifested in various mental disorders. Second-generation antipsychotics have been found to have a significant therapeutic effect on aggression, but they also cause side effectsSecond-generation antipsychotics have a greater effect on serotonergic receptors and may have a better effect on aggression than first-generation antipsychotics which mainly affect dopamine receptors. So far there are only a few indications that support the choice of a particular antipsychotic depending on the diagnostic category. It is important to further investigate the effectiveness of each antipsychotic in aggression as well as the search for efficiencies depending on the dosage of the drug agent, in order to create treatment protocols. In any case, the rational use of these drugs its necessary and at the same time an attempt must be made to de-escalate the aggressive behaviors with non-pharmacological methods.
