The “Outer Dimensions”: Impulsivity, Anger/Aggressiveness, Activation

  • Francesco Saverio BersaniEmail author
  • Massimo Pasquini


The “outer” SVARAD dimensions, impulsivity, anger/aggressiveness, and activation, represent trans-diagnostic psychological and behavioural domains that span traditional categorical boundaries. At the neurobiological level, the fronto-limbic and the fronto-cerebellar circuitry, as well as molecular pathways involving dopamine, serotonin, testosterone, and inflammatory mediators, play a crucial role in mediating the biological underpinnings of these psychopathological dimensions. From a clinical perspective, as the combination of clusters of symptoms differs from patient to patient and gives rise to a wide variety of clinical pictures even among subjects with the same diagnosis, it is important that the clinical features related to impulsivity, anger, aggressiveness, and activation are specifically and multiparametrically investigated and treated. The aim of the present chapter is to discuss the psychopathological aspects, the neurobiological underpinnings, and the clinical implications related to the “outer dimensions” in clinical psychiatry.


Impulsivity Anger Aggressiveness Activation Hyperactivity Disinhibition 


  1. 1.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013.CrossRefGoogle Scholar
  2. 2.
    Moeller FG, et al. Psychiatric aspects of impulsivity. Am J Psychiatry. 2001;158(11):1783–93.CrossRefGoogle Scholar
  3. 3.
    Biondi M, Pasquini M. Dimensional psychopharmacology of the cancer patient. In: Biondi M, Costantini A, Wise TN, editors. Psycho-oncology. Arlington, VA: American Psychiatric Publishing; 2013.Google Scholar
  4. 4.
    Pancheri P, et al. Costruzione della “SVARAD”, una scala per la valutazione rapida dimensionale. Rivista di Psichiatria. 1999;34:72–83.Google Scholar
  5. 5.
    Turecki G. Dissecting the suicide phenotype: the role of impulsive-aggressive behaviours. J Psychiatry Neurosci. 2005;30(6):398–408.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Hollander E, Rosen J. Impulsivity. J Psychopharmacol. 2000;14(2 Suppl 1):S39–44.PubMedCrossRefPubMedCentralGoogle Scholar
  7. 7.
    Insel T, et al. Research domain criteria (RDoC): toward a new classification framework for research on mental disorders. Am J Psychiatry. 2010;167(7):748–51.CrossRefGoogle Scholar
  8. 8.
    Oldham JM, Hollander E, Skodol AE. Impulsivity and compulsivity. Arlington, VA: American Psychiatric Publishing; 1996.Google Scholar
  9. 9.
    Berlin HA, Hollander E. Understanding the differences between impulsivity and compulsivity. Psychiatric Times, 2008;25(8).
  10. 10.
    Spielberger CD, Sarason IG. Stress and emotion. Didcot: Taylor & Francis; 1995.Google Scholar
  11. 11.
    Ekman P. An argument for basic emotions. Cognit Emot. 1992;6:169–200.CrossRefGoogle Scholar
  12. 12.
    Berkowitz L, Harmon-Jones E. Toward an understanding of the determinants of anger. Emotion. 2004;4(2):107–30.PubMedCrossRefPubMedCentralGoogle Scholar
  13. 13.
    Lee AH, DiGiuseppe R. Anger and aggression treatments: a review of meta-analyses. Curr Opin Psychol. 2018;19:65–74.PubMedCrossRefPubMedCentralGoogle Scholar
  14. 14.
    Vitiello B, Stoff DM. Subtypes of aggression and their relevance to child psychiatry. J Am Acad Child Adolesc Psychiatry. 1997;36(3):307–15.PubMedCrossRefPubMedCentralGoogle Scholar
  15. 15.
    Biondi M, et al. Dimensional psychopathology of depression: detection of an ‘activation’ dimension in unipolar depressed outpatients. J Affect Disord. 2005;84(2–3):133–9.PubMedPubMedCentralCrossRefGoogle Scholar
  16. 16.
    Day RK. Psychomotor agitation: poorly defined and badly measured. J Affect Disord. 1999;55(2–3):89–98.PubMedCrossRefPubMedCentralGoogle Scholar
  17. 17.
    Carroll BJ. Psychopathology and neurobiology of manic-depressive disorders. In: Carroll BJ, Barrett JE, editors. Psychopathology and the Brain. New York: Raven Press; 1991.Google Scholar
  18. 18.
    Siever LJ. Neurobiology of aggression and violence. Am J Psychiatry. 2008;165(4):429–42.PubMedPubMedCentralCrossRefGoogle Scholar
  19. 19.
    Blair RJ. The roles of orbital frontal cortex in the modulation of antisocial behavior. Brain Cogn. 2004;55(1):198–208.PubMedCrossRefPubMedCentralGoogle Scholar
  20. 20.
    Frith C, Dolan R. The role of the prefrontal cortex in higher cognitive functions. Brain Res Cogn Brain Res. 1996;5(1–2):175–81.PubMedCrossRefPubMedCentralGoogle Scholar
  21. 21.
    Beck A, Heinz A. Alcohol-related aggression-social and neurobiological factors. Dtsch Arztebl Int. 2013;110(42):711–5.PubMedPubMedCentralGoogle Scholar
  22. 22.
    Yudofsky SC, Silver JM, Hales RE. Cocaine and aggressive behavior: neurobiological and clinical perspectives. Bull Menn Clin. 1993;57(2):218–26.Google Scholar
  23. 23.
    Frazzetto G, et al. Early trauma and increased risk for physical aggression during adulthood: the moderating role of MAOA genotype. PLoS One. 2007;2(5):e486.PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    Sansone RA, Leung JS, Wiederman MW. Five forms of childhood trauma: relationships with aggressive behavior in adulthood. Prim Care Companion CNS Disord. 2012;14(5).
  25. 25.
    Dambacher F, et al. Reducing proactive aggression through non-invasive brain stimulation. Soc Cogn Affect Neurosci. 2015;10(10):1303–9.PubMedPubMedCentralCrossRefGoogle Scholar
  26. 26.
    Philipp-Wiegmann F, et al. Reduced cortical inhibition in violent offenders: a study with transcranial magnetic stimulation. Neuropsychobiology. 2011;64(2):86–92.PubMedCrossRefPubMedCentralGoogle Scholar
  27. 27.
    Riva P, et al. Reducing aggressive responses to social exclusion using transcranial direct current stimulation. Soc Cogn Affect Neurosci. 2015;10(3):352–6.PubMedCrossRefPubMedCentralGoogle Scholar
  28. 28.
    Thiebaut de Schotten M, et al. From Phineas Gage and Monsieur Leborgne to H.M.: Revisiting disconnection syndromes. Cereb Cortex. 2015;25(12):4812–27.PubMedPubMedCentralCrossRefGoogle Scholar
  29. 29.
    Harlow J. Recovery from the passage of an iron bar through the head. Publ Mass Med Soc. 1868;2:327–47.Google Scholar
  30. 30.
    Nicholl J, LaFrance WC Jr. Neuropsychiatric sequelae of traumatic brain injury. Semin Neurol. 2009;29(3):247–55.PubMedCrossRefPubMedCentralGoogle Scholar
  31. 31.
    Hazlett EA, et al. Reduced anterior and posterior cingulate gray matter in borderline personality disorder. Biol Psychiatry. 2005;58(8):614–23.PubMedCrossRefPubMedCentralGoogle Scholar
  32. 32.
    Raine A, et al. Hippocampal structural asymmetry in unsuccessful psychopaths. Biol Psychiatry. 2004;55(2):185–91.PubMedCrossRefPubMedCentralGoogle Scholar
  33. 33.
    Donegan NH, et al. Amygdala hyperreactivity in borderline personality disorder: implications for emotional dysregulation. Biol Psychiatry. 2003;54(11):1284–93.PubMedCrossRefPubMedCentralGoogle Scholar
  34. 34.
    Gobrogge KL, et al. Anterior hypothalamic neural activation and neurochemical associations with aggression in pair-bonded male prairie voles. J Comp Neurol. 2007;502(6):1109–22.PubMedCrossRefPubMedCentralGoogle Scholar
  35. 35.
    Goyer PF, et al. Positron-emission tomography and personality disorders. Neuropsychopharmacology. 1994;10(1):21–8.PubMedCrossRefPubMedCentralGoogle Scholar
  36. 36.
    Herpertz SC, et al. Evidence of abnormal amygdala functioning in borderline personality disorder: a functional MRI study. Biol Psychiatry. 2001;50(4):292–8.PubMedCrossRefPubMedCentralGoogle Scholar
  37. 37.
    Koenigsberg HW, et al. Neural correlates of emotion processing in borderline personality disorder. Psychiatry Res. 2009;172(3):192–9.PubMedPubMedCentralCrossRefGoogle Scholar
  38. 38.
    Catani M, et al. Beyond cortical localization in clinico-anatomical correlation. Cortex. 2012;48(10):1262–87.PubMedCrossRefPubMedCentralGoogle Scholar
  39. 39.
    Spencer TJ, et al. Overview and neurobiology of attention-deficit/hyperactivity disorder. J Clin Psychiatry. 2002;63(Suppl 12):3–9.PubMedPubMedCentralGoogle Scholar
  40. 40.
    Barkley RA. ADHD and the nature of self-control. New York: Guilford Press; 1997.Google Scholar
  41. 41.
    Minichino A, et al. The role of cerebellum in unipolar and bipolar depression: a review of the main neurobiological findings. Riv Psichiatr. 2014;49(3):124–31.PubMedPubMedCentralGoogle Scholar
  42. 42.
    Strick PL, Dum RP, Fiez JA. Cerebellum and nonmotor function. Annu Rev Neurosci. 2009;32:413–34.PubMedCrossRefPubMedCentralGoogle Scholar
  43. 43.
    King JA, et al. Neural substrates underlying impulsivity. Ann N Y Acad Sci. 2003;1008:160–9.PubMedCrossRefPubMedCentralGoogle Scholar
  44. 44.
    Lee AK, et al. Neural correlates of impulsivity factors in psychiatric patients and healthy volunteers: a voxel-based morphometry study. Brain Imaging Behav. 2011;5(1):52–64.PubMedCrossRefPubMedCentralGoogle Scholar
  45. 45.
    Moers-Hornikx VM, et al. Cerebellar nuclei are involved in impulsive behaviour. Behav Brain Res. 2009;203(2):256–63.PubMedCrossRefPubMedCentralGoogle Scholar
  46. 46.
    Schmahmann JD, Sherman JC. The cerebellar cognitive affective syndrome. Brain. 1998;121(Pt 4):561–79.PubMedCrossRefPubMedCentralGoogle Scholar
  47. 47.
    Schmahmann JD, Weilburg JB, Sherman JC. The neuropsychiatry of the cerebellum - insights from the clinic. Cerebellum. 2007;6(3):254–67.PubMedCrossRefPubMedCentralGoogle Scholar
  48. 48.
    Curatolo P, D'Agati E, Moavero R. The neurobiological basis of ADHD. Ital J Pediatr. 2010;36(1):79.PubMedPubMedCentralCrossRefGoogle Scholar
  49. 49.
    Miles DR, Carey G. Genetic and environmental architecture of human aggression. J Pers Soc Psychol. 1997;72(1):207–17.PubMedCrossRefPubMedCentralGoogle Scholar
  50. 50.
    Meyer-Lindenberg A, et al. Neural mechanisms of genetic risk for impulsivity and violence in humans. Proc Natl Acad Sci U S A. 2006;103(16):6269–74.PubMedPubMedCentralCrossRefGoogle Scholar
  51. 51.
    Brunner HG, et al. Abnormal behavior associated with a point mutation in the structural gene for monoamine oxidase A. Science. 1993;262(5133):578–80.CrossRefPubMedGoogle Scholar
  52. 52.
    Cases O, et al. Aggressive behavior and altered amounts of brain serotonin and norepinephrine in mice lacking MAOA. Science. 1995;268(5218):1763–6.PubMedPubMedCentralCrossRefGoogle Scholar
  53. 53.
    Kim JJ, et al. Selective enhancement of emotional, but not motor, learning in monoamine oxidase A-deficient mice. Proc Natl Acad Sci U S A. 1997;94(11):5929–33.PubMedPubMedCentralCrossRefGoogle Scholar
  54. 54.
    Deater-Deckard K, et al. Multiple risk factors in the development of externalizing behavior problems: group and individual differences. Dev Psychopathol. 1998;10(3):469–93.PubMedPubMedCentralCrossRefGoogle Scholar
  55. 55.
    Fergusson DM, Lynskey MT. Physical punishment/maltreatment during childhood and adjustment in young adulthood. Child Abuse Negl. 1997;21(7):617–30.PubMedCrossRefPubMedCentralGoogle Scholar
  56. 56.
    Marks DJ, et al. The interaction of psychosocial adversity and biological risk in childhood aggression. Psychiatry Res. 2007;151(3):221–30.PubMedCrossRefPubMedCentralGoogle Scholar
  57. 57.
    Kim-Cohen J, et al. MAOA, maltreatment, and gene-environment interaction predicting children's mental health: new evidence and a meta-analysis. Mol Psychiatry. 2006;11(10):903–13.PubMedCrossRefPubMedCentralGoogle Scholar
  58. 58.
    Reif A, et al. Nature and nurture predispose to violent behavior: serotonergic genes and adverse childhood environment. Neuropsychopharmacology. 2007;32(11):2375–83.PubMedCrossRefPubMedCentralGoogle Scholar
  59. 59.
    Linnoila M, et al. Low cerebrospinal fluid 5-hydroxyindoleacetic acid concentration differentiates impulsive from nonimpulsive violent behavior. Life Sci. 1983;33(26):2609–14.PubMedCrossRefPubMedCentralGoogle Scholar
  60. 60.
    Brunner D, Hen R. Insights into the neurobiology of impulsive behavior from serotonin receptor knockout mice. Ann N Y Acad Sci. 1997;836:81–105.PubMedCrossRefPubMedCentralGoogle Scholar
  61. 61.
    Davidge KM, et al. Association of the serotonin transporter and 5HT1Dbeta receptor genes with extreme, persistent and pervasive aggressive behaviour in children. Psychiatr Genet. 2004;14(3):143–6.PubMedCrossRefPubMedCentralGoogle Scholar
  62. 62.
    Mik HM, et al. Serotonin system genes and childhood-onset aggression. Psychiatr Genet. 2007;17(1):11.PubMedCrossRefPubMedCentralGoogle Scholar
  63. 63.
    Courtet P, et al. Association between violent suicidal behavior and the low activity allele of the serotonin transporter gene. Mol Psychiatry. 2001;6(3):338–41.PubMedCrossRefPubMedCentralGoogle Scholar
  64. 64.
    Potenza MN. How central is dopamine to pathological gambling or gambling disorder? Front Behav Neurosci. 2013;7:206.PubMedPubMedCentralCrossRefGoogle Scholar
  65. 65.
    Seo D, Patrick CJ, Kennealy PJ. Role of serotonin and dopamine system interactions in the neurobiology of impulsive aggression and its comorbidity with other clinical disorders. Aggress Violent Behav. 2008;13(5):383–95.PubMedPubMedCentralCrossRefGoogle Scholar
  66. 66.
    Daw ND, Kakade S, Dayan P. Opponent interactions between serotonin and dopamine. Neural Netw. 2002;15(4–6):603–16.CrossRefGoogle Scholar
  67. 67.
    Ferrari PF, et al. Accumbal dopamine and serotonin in anticipation of the next aggressive episode in rats. Eur J Neurosci. 2003;17(2):371–8.PubMedCrossRefPubMedCentralGoogle Scholar
  68. 68.
    van Erp AM, Miczek KA. Aggressive behavior, increased accumbal dopamine, and decreased cortical serotonin in rats. J Neurosci. 2000;20(24):9320–5.PubMedCrossRefPubMedCentralGoogle Scholar
  69. 69.
    Brain PF. Hormonal aspects of aggression and violence. In: N.R. Council, editor. Understanding and preventing violence, Biobehavioral influences, vol. 2. Washington, DC: The National Academies Press; 1994.Google Scholar
  70. 70.
    Fetissov SO, et al. Aggressive behavior linked to corticotropin-reactive autoantibodies. Biol Psychiatry. 2006;60(8):799–802.PubMedCrossRefPubMedCentralGoogle Scholar
  71. 71.
    Gower AL, Crick NR. Baseline autonomic nervous system arousal and physical and relational aggression in preschool: the moderating role of effortful control. Int J Psychophysiol. 2011;81(3):142–51.PubMedCrossRefPubMedCentralGoogle Scholar
  72. 72.
    Zalcman SS, Siegel A. The neurobiology of aggression and rage: role of cytokines. Brain Behav Immun. 2006;20(6):507–14.PubMedCrossRefPubMedCentralGoogle Scholar
  73. 73.
    Coccaro EF, Lee R, Coussons-Read M. Cerebrospinal fluid inflammatory cytokines and aggression in personality disordered subjects. Int J Neuropsychopharmacol. 2015;18(7):pyv001.PubMedPubMedCentralCrossRefGoogle Scholar
  74. 74.
    Coccaro EF, Lee R, Coussons-Read M. Elevated plasma inflammatory markers in individuals with intermittent explosive disorder and correlation with aggression in humans. JAMA Psychiat. 2014;71(2):158–65.CrossRefGoogle Scholar
  75. 75.
    Dazzi F, et al. Predictors of inpatient psychiatric admission in patients presenting to the emergency department: the role of dimensional assessment. Gen Hosp Psychiatry. 2015;37(6):587–94.PubMedPubMedCentralCrossRefGoogle Scholar
  76. 76.
    Tomko RL, et al. Measuring impulsivity in daily life: the momentary impulsivity scale. Psychol Assess. 2014;26(2):339–49.PubMedCrossRefPubMedCentralGoogle Scholar
  77. 77.
    Patton JH, Stanford MS, Barratt ES. Factor structure of the Barratt impulsiveness scale. J Clin Psychol. 1995;51(6):768–74.PubMedCrossRefPubMedCentralGoogle Scholar
  78. 78.
    Pancheri P, et al. Validazione della scala per la valutazione rapida dimensionale “SVARAD”. Riv Psichiatr. 1999;34:84–93.Google Scholar
  79. 79.
    Sunohara GA, et al. Effect of methylphenidate on attention in children with attention deficit hyperactivity disorder (ADHD): ERP evidence. Neuropsychopharmacology. 1999;21(2):218–28.PubMedCrossRefPubMedCentralGoogle Scholar
  80. 80.
    Harmon-Jones E, Barratt ES, Wigg C. Impulsiveness, aggression, reading, and the P300 of the event-related potential. Personal Individ Differ. 1997;22(4):439–45.CrossRefGoogle Scholar
  81. 81.
    Skeem JL, Monahan J. Current directions in violence risk assessment. Curr Dir Psychol Sci. 2011;20(1):38–42.CrossRefGoogle Scholar
  82. 82.
    Wehrmann T, Muller JM. An objective measure of hyperactivity aspects with compressed webcam video. Child Adolesc Psychiatry Ment Health. 2015;9:45.PubMedPubMedCentralCrossRefGoogle Scholar
  83. 83.
    Collett BR, Ohan JL, Myers KM. Ten-year review of rating scales. V: scales assessing attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 2003;42(9):1015–37.PubMedCrossRefPubMedCentralGoogle Scholar
  84. 84.
    Pasquini M, et al. Detection and treatment of depressive and anxiety disorders among cancer patients: feasibility and preliminary findings from a liaison service in an oncology division. Depress Anxiety. 2006;23(7):441–8.PubMedPubMedCentralCrossRefGoogle Scholar
  85. 85.
    Pasquini M, et al. Relevance of anger and irritability in outpatients with major depressive disorder. Psychopathology. 2004;37(4):155–60.PubMedPubMedCentralCrossRefGoogle Scholar
  86. 86.
    Pasquini M, et al. Combining an SSRI with an anticonvulsant in depressed patients with dysphoric mood: an open study. Clin Pract Epidemiol Ment Health. 2007;3:3.PubMedPubMedCentralCrossRefGoogle Scholar
  87. 87.
    Picardi A, et al. Higher levels of anger and aggressiveness in major depressive disorder than in anxiety and somatoform disorders. J Clin Psychiatry. 2004;65(3):442–3.PubMedPubMedCentralCrossRefGoogle Scholar
  88. 88.
    Abraham K. Notes on the psychoanalytical investigation of manic-depressive insanity and allied conditions. In: Abraham K, editor. Selected papers of Karl Abraham. London: Hogarth Press; 1948.Google Scholar
  89. 89.
    Freud S. Mourning and melancholia. In: Strachey J, editor. Standard edition of the complete psychological works of Sigmund Freud, vol. 14. London: Hogarth Press; 1975.Google Scholar
  90. 90.
    Guidano VF. Complexity of the self. New York: Guilford Press; 1987.Google Scholar
  91. 91.
    Leopardi G. Zibaldone. Milan: Mondadori Editore; 1996.Google Scholar
  92. 92.
    Stanghellini G. Dysphoria, vulnerability and identity. An eulogy for anger. Psychopathology. 2000;33(4):198–203.PubMedCrossRefPubMedCentralGoogle Scholar
  93. 93.
    Fava GA, et al. Hostility and recovery from melancholia. J Nerv Ment Dis. 1986;174(7):414–7.PubMedCrossRefPubMedCentralGoogle Scholar
  94. 94.
    Fava M, Rosenbaum JF. Anger attacks in depression. Depress Anxiety. 1998;8(Suppl 1):59–63.PubMedCrossRefPubMedCentralGoogle Scholar
  95. 95.
    Pull CB, et al. The principal dimensions of manifest depression. A factor analysis of manifest depressive symptomatology. Neuropsychobiology. 1979;5(4):207–12.PubMedCrossRefPubMedCentralGoogle Scholar
  96. 96.
    Overall JE, Hollister LE. Phenomenological classification of depressive disorders. J Clin Psychol. 1980;36(2):372–7.PubMedCrossRefPubMedCentralGoogle Scholar
  97. 97.
    Riley WT, Treiber FA, Woods MG. Anger and hostility in depression. J Nerv Ment Dis. 1989;177(11):668–74.PubMedCrossRefPubMedCentralGoogle Scholar
  98. 98.
    Posternak MA, Zimmerman M. Anger and aggression in psychiatric outpatients. J Clin Psychiatry. 2002;63(8):665–72.PubMedCrossRefPubMedCentralGoogle Scholar
  99. 99.
    Sato T, et al. Frequency of manic symptoms during a depressive episode and unipolar ‘depressive mixed state’ as bipolar spectrum. Acta Psychiatr Scand. 2003;107(4):268–74.PubMedCrossRefPubMedCentralGoogle Scholar
  100. 100.
    Koh KB, Kim CH, Park JK. Predominance of anger in depressive disorders compared with anxiety disorders and somatoform disorders. J Clin Psychiatry. 2002;63(6):486–92.PubMedCrossRefPubMedCentralGoogle Scholar
  101. 101.
    Piacentino D, et al. The Association of anger with symptom subtypes in severe obsessive-compulsive disorder outpatients. Psychopathology. 2016;49(1):40–6.PubMedPubMedCentralCrossRefGoogle Scholar
  102. 102.
    Carni S, et al. Intrapsychic and interpersonal guilt: a critical review of the recent literature. Cogn Process. 2013;14(4):333–46.PubMedCrossRefPubMedCentralGoogle Scholar
  103. 103.
    McElroy SL, Phillips KA, Keck PE Jr. Obsessive compulsive spectrum disorder. J Clin Psychiatry. 1994;55(Suppl):33–51. discussion 52-3PubMedPubMedCentralGoogle Scholar
  104. 104.
    Hansen DJ, St Lawrence JS, Christoff KA. Effects of interpersonal problem-solving training with chronic aftercare patients on problem-solving component skills and effectiveness of solutions. J Consult Clin Psychol. 1985;53:167–74.PubMedCrossRefPubMedCentralGoogle Scholar
  105. 105.
    Shure MB, Spivack G. Interpersonal problem solving in young children: a cognitive approach to prevention. Am J Community Psychol. 1982;10:341–56.PubMedCrossRefPubMedCentralGoogle Scholar
  106. 106.
    Intagliata J. Increasing the interpersonal problem-solving skills of an alcoholic population. J Consult Clin Psychol. 1978;46:489–98.PubMedCrossRefPubMedCentralGoogle Scholar
  107. 107.
    Platt JJ, McKim P, Husband SD. TIPS: training in interpersonal problem solving: enhanced health promotion and AIDS prevention program. Trainer’s Manual: Camden, University of Medicine and Dentistry of New Jersey; 1990.Google Scholar
  108. 108.
    Baer RA, Nietzel MT. Cognitive and behavioral treatment of impulsivity in children: a meta-analytic review of the outcome literature. J Clin Child Psychol. 1991;20:400–12.CrossRefGoogle Scholar
  109. 109.
    Edmondson CB, Conger JC. A review of treatment efficacy for individuals with anger problems: conceptual, assessment, and methodological issues. Clin Psychol Rev. 1996;16(3):251–75.CrossRefGoogle Scholar
  110. 110.
    Del Vecchio T, O'Leary KD. Effectiveness of anger treatments for specific anger problems: a meta-analytic review. Clin Psychol Rev. 2004;24(1):15–34.PubMedCrossRefPubMedCentralGoogle Scholar
  111. 111.
    Saini M. A meta-analysis of the psychological treatment of anger: developing guidelines for evidence-based practice. J Am Acad Psychiatry Law. 2009;37(4):473–88.PubMedCrossRefPubMedCentralGoogle Scholar
  112. 112.
    Paul GL. Strategy of outcome research in psychotherapy. J Consult Psychol. 1967;31(2):109–18.PubMedCrossRefPubMedCentralGoogle Scholar
  113. 113.
    Marchand WR. Neural mechanisms of mindfulness and meditation: evidence from neuroimaging studies. World J Radiol. 2014;6(7):471–9.PubMedPubMedCentralCrossRefGoogle Scholar
  114. 114.
    Fournier JC, Price RB. Psychotherapy and neuroimaging. Focus (Am Psychiatr Publ). 2014;12(3):290–8.Google Scholar
  115. 115.
    Malone RP, et al. A double-blind placebo-controlled study of lithium in hospitalized aggressive children and adolescents with conduct disorder. Arch Gen Psychiatry. 2000;57(7):649–54.PubMedCrossRefPubMedCentralGoogle Scholar
  116. 116.
    Campbell M, et al. Lithium in hospitalized aggressive children with conduct disorder: a double-blind and placebo-controlled study. J Am Acad Child Adolesc Psychiatry. 1995;34(4):445–53.PubMedCrossRefPubMedCentralGoogle Scholar
  117. 117.
    Tariot PN, et al. Efficacy and tolerability of carbamazepine for agitation and aggression in dementia. Am J Psychiatry. 1998;155(1):54–61.PubMedCrossRefPubMedCentralGoogle Scholar
  118. 118.
    Donovan SJ, et al. Divalproex treatment for youth with explosive temper and mood lability: a double-blind, placebo-controlled crossover design. Am J Psychiatry. 2000;157(5):818–20.PubMedCrossRefPubMedCentralGoogle Scholar
  119. 119.
    Goldstein MR, Mascitelli L. Is violence in part a lithium deficiency state? Med Hypotheses. 2016;89:40–2.PubMedCrossRefPubMedCentralGoogle Scholar
  120. 120.
    Coccaro EF, Kavoussi RJ. Fluoxetine and impulsive aggressive behavior in personality-disordered subjects. Arch Gen Psychiatry. 1997;54(12):1081–8.PubMedCrossRefPubMedCentralGoogle Scholar
  121. 121.
    McDougle CJ, et al. A double-blind, placebo-controlled study of fluvoxamine in adults with autistic disorder. Arch Gen Psychiatry. 1996;53(11):1001–8.PubMedCrossRefPubMedCentralGoogle Scholar
  122. 122.
    Vartiainen H, et al. Citalopram, a selective serotonin reuptake inhibitor, in the treatment of aggression in schizophrenia. Acta Psychiatr Scand. 1995;91(5):348–51.PubMedCrossRefPubMedCentralGoogle Scholar
  123. 123.
    Nischal A, Tripathi A, Trivedi JK. Suicide and antidepressants: what current evidence indicates. Mens Sana Monogr. 2012;10(1):33–44.PubMedPubMedCentralCrossRefGoogle Scholar
  124. 124.
    Katz IR, et al. Comparison of risperidone and placebo for psychosis and behavioral disturbances associated with dementia: a randomized, double-blind trial. Risperidone Study Group. J Clin Psychiatry. 1999;60(2):107–15.PubMedCrossRefPubMedCentralGoogle Scholar
  125. 125.
    De Deyn PP, et al. A randomized trial of risperidone, placebo, and haloperidol for behavioral symptoms of dementia. Neurology. 1999;53(5):946–55.PubMedCrossRefPubMedCentralGoogle Scholar
  126. 126.
    McDougle CJ, et al. A double-blind, placebo-controlled study of risperidone in adults with autistic disorder and other pervasive developmental disorders. Arch Gen Psychiatry. 1998;55(7):633–41.PubMedCrossRefPubMedCentralGoogle Scholar
  127. 127.
    Findling RL, et al. A double-blind pilot study of risperidone in the treatment of conduct disorder. J Am Acad Child Adolesc Psychiatry. 2000;39(4):509–16.PubMedCrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Human NeurosciencesSapienza University of RomeRomeItaly

Personalised recommendations