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Treating Aggressive Behavior in Psychiatric Inpatients: The Efficacy of Different GABAergic Agents, Benzodiazepines, and Z Drugs

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Handbook of Anger, Aggression, and Violence

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Abstract

GABAA receptor positive allosteric modulators (PAM), such as benzodiazepines, may either reduce or enhance violence. This review of the literature found evidence that lorazepam, midazolam, and clonazepam are effective in managing agitation and/or aggression in clinical settings. The efficacy of flunitrazepam is also supported by a more limited number of studies. One single retrospective observational study has proposed preliminary evidence of the anti-aggressive efficacy of zopiclone. Alprazolam, chlordiazepoxide, and diazepam may increase hostility, at least in normal volunteers, during controlled laboratory experiments. Drugs with demonstrated anti-aggressive efficacy have stronger affinity for α1/α2 than α3/α5 GABAA receptor subunits.

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Abbreviations

ABS:

Agitated Behavior Scale

ACES:

Calmness Evaluation Scale

AUC:

Area under the curve

BDHI:

Buss-Durkee Hostility Inventory

BZD:

Benzodiazepine

CADTH:

Canadian Agency for Drugs and Technologies in Health

CGI-S:

Clinical global improvement-severity

CRTT:

Competitive reaction time task

EC50:

Half maximal effective concentration

GABA:

Gamma-aminobutyric acid

HIPS:

Hostility Interpersonal Perception Scale

IM:

Intramuscular

IV:

Intravenous

LOCF:

Last observation carried forward

PAM:

Positive allosteric modulator

PANSS-EC:

Positive and Negative Syndrome Scale – Excited Component

RCT:

Randomized controlled trial

ROC:

Receiver operating characteristic

SOAS-R:

Staff Observation Aggression Scale-Revised

SUCRA:

Surface under the cumulative ranking curve

TAP:

Taylor Aggression Paradigm

TAT:

Thematic Apperception Test

WT:

Wild type

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Authors and Affiliations

  1. Department of Psychiatry, University of Alberta, Edmonton, AB, Canada

    Alfonso Ceccherini-Nelli

  2. Alberta Health Care Services, Alberta Hospital Edmonton, Edmonton, AB, Canada

    Alfonso Ceccherini-Nelli & Janice Orris

Authors
  1. Alfonso Ceccherini-Nelli
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  2. Janice Orris
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Correspondence to Alfonso Ceccherini-Nelli .

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Editors and Affiliations

  1. Institute for Clinical and Applied Health Research, University of Hull, Hull, UK

    Colin Martin

  2. King's College London, London, UK

    Victor R. Preedy

  3. University of Westminster, London, UK

    Vinood B. Patel

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Ceccherini-Nelli, A., Orris, J. (2022). Treating Aggressive Behavior in Psychiatric Inpatients: The Efficacy of Different GABAergic Agents, Benzodiazepines, and Z Drugs. In: Martin, C., Preedy, V.R., Patel, V.B. (eds) Handbook of Anger, Aggression, and Violence. Springer, Cham. https://doi.org/10.1007/978-3-030-98711-4_111-1

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  • DOI: https://doi.org/10.1007/978-3-030-98711-4_111-1

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