Pharmacotherapy for the treatment of aggressive behavior in general adult psychiatry: A systematic review
Pharmacotherapy for the treatment of aggressive behavior in general adult psychiatry: A systematic review
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DOI：
10.4088/jcp.v67n0702
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发表时间：
2006-07-01
影响因子：
5.3
通讯作者：
Egberts, Toine C. G.
中科院分区：
文献类型：
--
作者：
Goedhard, Laurette E.;Stolker, Joost J.;Egberts, Toine C. G.
目的：系统回顾一般成人精神病学中外向攻击行为的药物治疗证据。数据来源：使用 1966 年至 2005 年 3 月在 PubMed、EMBASE、PsycINFO 和 Cochrane 图书馆中的文献检索来识别相关研究。检索关键词“攻击性”、“暴力”、“愤怒”、“敌意”与“药物治疗”、“精神药物”、“肾上腺素能P拮抗剂”、“抗惊厥药”、“抗抑郁药”、“抗精神病药”、“苯二氮卓类药物”、“锂”等。此外，还检索了检索到的出版物以获取其他参考文献。研究选择：所有针对攻击行为或攻击相关症状的药物治疗的随机对照试验均包括在内，但针对“紧急情况”的研究以及在专门的精神病学或非精神病学环境中进行的研究除外。数据提取：使用“最佳证据原则”进行证据合成。两位作者独立判定了方法学质量和日常临床实践的普遍性。数据综合：35 项随机对照试验符合纳入标准并进行了评估。基于最佳证据综合模型，发现抗精神病药、抗抑郁药、抗惊厥药和 P-肾上腺素能阻断药的抗攻击作用的证据较弱。非典型抗精神病药物似乎优于典型抗精神病药物。个别研究中使用的各种结果衡量标准和数据报告不足阻碍了跨研究疗效的定量评估。现有随机对照试验的进一步局限性包括样本量小、研究持续时间短以及对日常临床实践环境的普遍性较差。结论：虽然药物治疗经常应用于侵袭性患者，但仅发现各种药物类别疗效的证据微弱。对于未来的研究，有必要就临床试验中攻击性测量量表的使用达成共识。 Furthermore, large-scale trials with more naturalistic designs, as opposed to classical randomized controlled trials with strict inclusion and exclusion criteria, may be advisable in order to obtain results that are more generalizable to daily clinical practice.
Objective: To systematically review the evidence for pharmacologic management of outwardly directed aggressive behavior in general adult psychiatry.Data Sources: Literature searches in PubMed, EMBASE, PsycINFO, and Cochrane libraries from 1966 through March 2005 were used to identify relevant studies. The keywords aggression, violence, anger, and hostility combined with drug therapy, psychotropic drugs, adrenergic P-antagonists, anticonvulsants, antidepressants, antipsychotic agents, benzodiazepines, and lithium were searched. Furthermore, the retrieved publications were searched for additional references.Study Selection: All randomized controlled trials addressing pharmacotherapy for aggression or aggression-related symptoms were included, except studies addressing the "emergency situation" and studies conducted in specialized psychiatric or non-psychiatric settings.Data Extraction: Evidence synthesis was performed using the "best-evidence principle." Two authors independently adjudicated methodological quality and generalizability to daily clinical practice. Data Synthesis: Thirty-five randomized controlled trials met the inclusion criteria and were evaluated. On the basis of a best-evidence synthesis model, weak evidence for antiaggressive effects of antipsychotics, antidepressants, anticonvulsants, and P-adrenergic-blocking drugs was found. Atypical antipsychotics appeared superior to typical antipsychotics. The use of various outcome measures and insufficient data reporting in the individual studies hampered the quantitative assessment of efficacy across studies. Further limitations of the available randomized controlled trials included small sample sizes, short study duration, and poor generalizability to daily clinical practice setting.Conclusions: Whereas pharmacotherapy is frequently applied in aggressive patients, only weak evidence of efficacy of various drug classes was found. Consensus about the use of aggression measurement scales in clinical trials is necessary for future research. Furthermore, large-scale trials with more naturalistic designs, as opposed to classical randomized controlled trials with strict inclusion and exclusion criteria, may be advisable in order to obtain results that are more generalizable to daily clinical practice.