A controlled trial of phenytoin in impulsive aggression.
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Biomedical subjects
Publications and source records attributed to A R Felthous.
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In a study of violent men, 443 symptomatic adult male volunteers were evaluated for presence of intermittent explosive disorder (IED). Investigators first established presence of severe and frequent violent outbursts not readily explainable by another disorder. Seventy-nine violent men were so selected. Of these, 26 had excessive impulsivity, an exclusionary criterion for IED. Twenty-one were excluded because of other, exclusionary mental disorders. Violent behavior of five subjects was deemed proportionate to the provocation. Insufficient data were obtained for an accurate diagnoses of IED in 12 subjects. Fifteen subjects satisfied all criteria for IED, i.e., 18.9 percent of sufficiently violent men without other major psychopathology or 1.49 percent of all 443 men who complained of violence. Epidemiologic and validity aspects of IED are discussed.
With the growing impact of legal regulation of clinical practice, students of medicine and other clinical specialties need to know how these developing legal concepts apply to their future practices.
Blood platelet uptake of 3H-serotonin (5HT uptake), a potential marker of serotonergic function, was determined in male outpatients with episodic aggression (n = 15) and in age- and sex-matched nonaggressive controls (n = 15). Correlations with rating scales of "impulsivity" (Barratt Impulsivity Scale, 10th revision) and "anger" (Spielberger Anger Expression Scale) were performed. Mean 5HT uptake was 18% lower in patients with episodic aggression. A significant negative correlation between % difference in platelet 5HT uptake and impulsivity score was observed, but the correlation between 5HT uptake and anger was not significant. These results support the hypothesis of disturbed serotonergic function in aggression and suggest that the primary relationship is in the "control" of aggression. The blood platelet may be useful in identifying impulsive subtypes.
Are separate courses on forensic psychiatry available for medical students? During the 1985 to 1986 academic year, the authors surveyed all U.S. medical schools to identify courses on forensic/legal psychiatry. A minority of schools included separate courses or practicums on forensic psychiatry or mental health law. In a follow-up telephone survey, instructors of each of these courses were interviewed. Information was obtained on format of course, duration, discipline of instructor or instructors, topics covered, reading materials, institutional settings, and the number of students who took the course. The results are discussed and compared with earlier surveys.
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The full childhood triad of enuresis, firesetting, and cruelty to animals is seldom reported by patients in acute care psychiatric facilities. Two of the three elements have been reported with greater frequency and constitute useful diagnostic information. Literature on the triad has been reviewed and data from three studies have been presented. The authors concluded that a history of two thirds of the triad is significantly associated with aggressive behaviours directed against people.
This two-part study explores the potential for assaultive behavior in females. The first part compares assaultive and nonassaultive female offenders for the presence of specific historical variables, and finds several significant differences. In the second part, the total female offender sample is compared with a male offender sample for presence of the same variables. The nearly equal incidence of several variables in both samples, such as persistent enuresis and firesetting, suggests a need for reassessment of some traditional theoretical formulations.
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