Understanding and Preventing Violence, Volume 2: Biobehavioral Influences (1994)
Chapter: Beta-Blockers
the GABAA-benzodiazepine receptor complex, fully or in part, has increased greatly in number and in selectivity (Haefely, 1990). Promising evidence indicates that benzodiazepine receptor antagonists such as flumazenil effectively reduce the heightened aggressive behavior after alcohol in rats and monkeys (Weerts et al., 1993). The clinical potential of benzodiazepine receptor partial agonists and antagonists in the treatment of violent individuals needs to be explored.
5-HT Anxiolytics
During the last decade, buspirone emerged as prototypic substance for a new class of anxiolytic drugs with the 5-HT1A receptor subtype as primary site of action (Taylor, 1988). These drugs have begun to be explored for their use in the pharmacotherapeutic management of aggressive and violent individuals. In a few available animal studies, buspirone, ipsapirone, and gepirone reduced aggressive and defensive responses with modest specificity for aggressive elements of behavior (Table 10A; e.g., Olivier et al., 1984, 1989). Two recent studies in 24 mentally retarded patients showed that buspirone eventually decreases aggressive and self-injurious behavior without sedation or tolerance (Ratey et al., 1989; Ratey and Driscoll, 1989). It is important to point to the requirement of repeated drug administrations over days and weeks before the therapeutic effects of buspirone and similar 5-HT anxiolytics fully emerge (e.g., Barrett and Witkin, 1991). Whether or not these new 5-HT1A anxiolytics prove to be more effective in controlling intense assaultive and combative behavior and less problematic in terms of side effects than existing substances remains to be demonstrated. Systematic evidence needs to be gathered as to which type of aggressive or violent behavior is most effectively reduced by these anxiolytics, and which treatment conditions are required for therapeutic success.
Beta-Blockers
Ever since Elliott (1977) resorted to the cardiovascular drug propranolol to reduce aggressive outbursts in seven belligerent patients, a series of open clinical trials confirmed the clinical success in several patient populations. Specifically, propranolol and other beta-blockers reduce irritability, self-injurious behavior, violent outbursts, and assaultive and destructive behavior in patients diagnosed as mentally retarded, brain damaged, schizophrenics, psychotics, autistic, Korsakoff, or organic brain disease (see Table 11;
