This Article  • References  • Full text PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Emil F. Coccaro, MD; Richard J. Kavoussi, MD

Arch Gen Psychiatry. 1997;54(12):1081-1088.

Abstract
Background
Evidence of an inverse relationship between central serotonergic (serotonin [5-hydroxytryptamine]) system function and impulsive aggressive behavior has been accumulating for more than 2 decades. If so, pharmacological enhancement of serotonin activity should be expected to reduce impulsive aggressive behavior in subjects in whom this behavior is prominent.

Methods
A double-blind, placebo-controlled trial of the selective serotonin-uptake inhibitor fluoxetine hydrochloride was conducted in 40 nonmajor-depressed, nonbipolar or schizophrenic, DSM-III-R personality—disordered individuals with current histories of impulsive aggressive behavior and irritability. Measures included the Overt Aggression Scale—Modified for Outpatients, Clinical Global Impression Rating of Improvement, and several secondary measures of aggression, depression, and anxiety.

Results
Fluoxetine, but not placebo, treatment resulted in a sustained reduction in scores on the lrritability and Aggression subscales of the Overt Aggression Scale—Modified for Outpatients that was first apparent during months 2 and 3 of treatment, respectively. Fluoxetine was superior to placebo in the proportion of "responders" on the Clinical Global Impression Rating of Improvement: first at the end of month 1, and then finally demonstrating a sustained drug-placebo difference from the end of month 2 through the end of month 3 of treatment. These results were not influenced by secondary measures of depression, anxiety, or alcohol use.

Conclusion
Fluoxetine treatment has an antiaggressive effect on impulsive aggressive individuals with DSM-III-R personality disorder.

Author Affiliations
From the Clinical Neuroscience Research Unit, Department of Psychiatry, MCP Hahnemann School of Medicine, Allegheny University of the Health Sciences, Philadelphia, Pa.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Olanzapine for the treatment of borderline personality disorder: variable dose 12-week randomised double-blind placebo-controlled study
Schulz et al.
Br. J. Psychiatry 2008;193:485-492.
ABSTRACT | FULL TEXT  

Why are programmes for offenders with personality disorder not informed by the relevant scientific findings?
Duggan
Phil Trans R Soc B 2008;363:2599-2612.
ABSTRACT | FULL TEXT  

Language and the Modulation of Impulsive Aggression
Miller et al.
J. Neuropsychiatry Clin. Neurosi. 2008;20:261-273.
ABSTRACT | FULL TEXT  

Neurobiology of Aggression and Violence
Siever
Am. J. Psychiatry 2008;165:429-442.
ABSTRACT | FULL TEXT  

Evaluating Three Treatments for Borderline Personality Disorder: A Multiwave Study
Clarkin et al.
Am. J. Psychiatry 2007;164:922-928.
ABSTRACT | FULL TEXT  

References
APPI Online CME 2007;2007:2-2.
FULL TEXT  

Categorization of Aggressive Acts Committed by Chronically Assaultive State Hospital Patients
Quanbeck et al.
Psychiatr. Serv. 2007;58:521-528.
ABSTRACT | FULL TEXT  

The Prevalence and Correlates of DSM-IV Intermittent Explosive Disorder in the National Comorbidity Survey Replication.
Kessler et al.
Arch Gen Psychiatry 2006;63:669-678.
ABSTRACT | FULL TEXT  

Psychodynamic Approaches to Personality Disorders
Gabbard
Focus 2005;3:363-367.
ABSTRACT | FULL TEXT  

Borderline personality disorder
Paris
CMAJ 2005;172:1579-1583.
ABSTRACT | FULL TEXT  

Mind, Brain, and Personality Disorders
Gabbard
Am. J. Psychiatry 2005;162:648-655.
ABSTRACT | FULL TEXT  

Treatment Recommendations for the Use of Antipsychotics for Aggressive Youth (TRAAY), Part I: A Review
Schur et al.
Focus 2004;2:596-607.
ABSTRACT | FULL TEXT  

Drug treatment for personality disorders
Tyrer and Bateman
Adv. Psychiatr. Treat. 2004;10:389-398.
ABSTRACT | FULL TEXT  

In socially isolated mice, the reversal of brain allopregnanolone down-regulation mediates the anti-aggressive action of fluoxetine
Pinna et al.
Proc. Natl. Acad. Sci. USA 2003;100:2035-2040.
ABSTRACT | FULL TEXT  

SSRI Treatment of Borderline Personality Disorder: A Randomized, Placebo-Controlled Clinical Trial for Female Patients With Borderline Personality Disorder
Rinne et al.
Am. J. Psychiatry 2002;159:2048-2054.
ABSTRACT | FULL TEXT  

Motivation, working memory, and decision making: a cognitive-motivational theory of personality vulnerability to alcoholism.
Finn
Behav Cogn Neurosci Rev 2002;1:183-205.
ABSTRACT  

Evidence for a dysfunctional prefrontal circuit in patients with an impulsive aggressive disorder
Best et al.
Proc. Natl. Acad. Sci. USA 2002;99:8448-8453.
ABSTRACT | FULL TEXT  

Serotonin Transporter Distribution and Density in the Cerebral Cortex of Alcoholic and Nonalcoholic Comparison Subjects: A Whole-Hemisphere Autoradiography Study
Mantere et al.
Am. J. Psychiatry 2002;159:599-606.
ABSTRACT | FULL TEXT  

The distinction between personality disorder and mental illness
KENDELL
Br. J. Psychiatry 2002;180:110-115.
ABSTRACT | FULL TEXT  

Psychiatric Aspects of Impulsivity
Moeller et al.
Am. J. Psychiatry 2001;158:1783-1793.
ABSTRACT | FULL TEXT  

Comparison between noradrenergic and serotonergic medications using the Social Adjustment Scale: is drive enhancement necessary for recovery of social functioning?
Luty et al.
J Psychopharmacol 2001;15:257-264.
ABSTRACT  

Personality disorder
Tyrer
Br. J. Psychiatry 2001;179:81-84.
FULL TEXT  

Efficacy and Safety of Fluoxetine in the Treatment of Patients With Major Depression After First Myocardial Infarction: Findings From a Double-Blind, Placebo-Controlled Trial
Strik et al.
Psychosom. Med. 2000;62:783-789.
ABSTRACT | FULL TEXT  

Dysfunction in the Neural Circuitry of Emotion Regulation--A Possible Prelude to Violence
Davidson et al.
Science 2000;289:591-594.
ABSTRACT | FULL TEXT  

Fluoxetine reduced impulsive aggressive behaviour in patients with a personality disorder
Hawton
Evid. Based Ment. Health 1998;1:79-79.
FULL TEXT  

Cerebrospinal Fluid Vasopressin Levels: Correlates With Aggression and Serotonin Function in Personality-Disordered Subjects
Coccaro et al.
Arch Gen Psychiatry 1998;55:708-714.
ABSTRACT | FULL TEXT  

Anti-Aggressive Effect of SSRIs
JWatch Psychiatry 1998;1998:8-8.
FULL TEXT