Zusammenfassung
Impulsive Aggression stellt ein häufiges Merkmal bei psychopathischen Störungen dar und kann mit Psychopharmaka behandelt werden. Aus kontrollierten Studien ergeben sich für die folgenden gegen impulsive Aggression eingesetzten Wirkstoffe („anti-impulsive aggressive agent“, AIAA) die stärksten Wirksamkeitsnachweise: Fluoxetin, Phenytoin, Divalproex/Valproat, Carbamazepin/Oxcarbazepin und Lithiumsalz. Diese Übersichtsarbeit beschreibt, ausgehend von einer Risiko-Nutzen-Analyse und der Studienlage in den USA, die Auswahl und den Einsatz eines möglichst gut geeigneten AIAA bei Patienten mit psychopathischer Störung. Dabei werden positive und negative Gesichtspunkte für die Auswahl, die Anwendung sowie mögliche Wirkmechanismen des jeweiligen AIAA umrissen. Des Weiteren werden Möglichkeiten zur Behandlung von impulsiver Aggression bei Patienten erörtert, bei denen ein AIAA keine Besserung gebracht hat.
Abstract
Impulsive aggression is a frequently occurring feature of psychopathic disorders and can be treated by pharmacotherapy. Controlled studies resulted in the use of the following agents for treatment of impulsive aggression (anti-impulsive aggression agents, AIAA) with the strongest evidence for efficacy: fluoxetine, phenytoin, divalproex/valproate, carbamazepine/oxycarbamazepine, and lithium. Starting from a risk-benefit analysis and research in the USA, this overview describes the selection and prescription of best possible AIAA suited for patients with psychopathic disorders. Positive and negative aspects for the selection and the prescription as well as possible mechanisms of action of the respective AIAAs are outlined. Furthermore, possibilities for the treatment of impulsive aggression in patients for whom an AIAA brought no improvement are explained.
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Felthous, A.R., Stanford, M.S. & Saß, H. Zur Pharmakotherapie impulsiver Aggression bei antisozialen und psychopathischen Störungen. Forens Psychiatr Psychol Kriminol 12, 266–278 (2018). https://doi.org/10.1007/s11757-018-0491-2
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DOI: https://doi.org/10.1007/s11757-018-0491-2