The Psychopharmacology of Aggressive Behavior: A Translational Approach Part 2: Clinical Studies Using Atypical Antipsychotics, Anticonvulsants, and Lithium
The Psychopharmacology of Aggressive Behavior: A Translational Approach Part 2: Clinical Studies Using Atypical Antipsychotics, Anticonvulsants, and Lithium
复制标题
DOI：
10.1097/jcp.0b013e31824929d6
复制
发表时间：
2012-04-01
影响因子：
2.9
通讯作者：
Gobbi, Gabriella
中科院分区：
文献类型：
--
作者：
Comai, Stefano;Tau, Michael;Gobbi, Gabriella
患有精神疾病的患者发展攻击性行为的风险较高。在过去的10年里，由于市场上非典型抗精神病药的引入以及抗惊厥药和锂在治疗攻击性患者中的使用增加，攻击性的精神药理学治疗发生了巨大变化。（2部分的第二部分）使用转化医学的方法来研究侵略的神经生物学，讨论了其发病机制中涉及的主要神经递质系统（5-羟色胺、谷氨酸、去甲肾上腺素、多巴胺和F-氨基丁酸）以及在攻击行为治疗中使用非典型抗精神病药、抗惊厥药和锂的神经药理学原理。对所有使用非典型抗精神病药（阿立哌唑、氯氮平、洛沙丁胺醇、奥氮平、奎替利、利培酮、齐拉西酮和氨磺必利）、抗惊厥药（托吡酯、丙戊酸盐、拉莫三嗪和加巴喷丁）和锂的临床试验进行了严格审查。鉴于攻击行为的复杂性和多面性，针对不同受体的多功能综合疗法似乎是治疗攻击行为的最佳策略。这种治疗策略得到了转化研究和一些人体研究的支持，即使需要额外的随机，双盲，临床试验来证实这种框架的临床疗效。
Patients experiencing mental disorders are at an elevated risk for developing aggressive behavior. In the past 10 years, the psychopharmacological treatment of aggression has changed dramatically owing to the introduction of atypical antipsychotics on the market and the increased use of anticonvulsants and lithium in the treatment of aggressive patients.This review (second of 2 parts) uses a translational medicine approach to examine the neurobiology of aggression, discussing the major neurotransmitter systems implicated in its pathogenesis (serotonin, glutamate, norepinephrine, dopamine, and F-aminobutyric acid) and the neuropharmacological rationale for using atypical antipsychotics, anticonvulsants, and lithium in the therapeutics of aggressive behavior. A critical review of all clinical trials using atypical antipsychotics (aripiprazole, clozapine, loxapine, olanzapine, quetiapine, risperidone, ziprasidone, and amisulpride), anticonvulsants (topiramate, valproate, lamotrigine, and gabapentin), and lithium are presented. Given the complex, multifaceted nature of aggression, a multifunctional combined therapy, targeting different receptors, seems to be the best strategy for treating aggressive behavior. This therapeutic strategy is supported by translational studies and a few human studies, even if additional randomized, double-blind, clinical trials are needed to confirm the clinical efficacy of this framework.