Understanding and Preventing Violence, Volume 2: Biobehavioral Influences (1994)
Chapter: Norepinephrine
that render them problematic as treatment options, representing little more than a form of "chemical restraint." Antipsychotic drugs that are antagonists at D2 dopamine receptors show a wide range of behavioral activities and, when used chronically, lead to various neurologic problems.
Cocaine and amphetamine activate behavior and engender euphoria in all likelihood via action on brain dopamine receptors. The broad spectrum of behavioral and mood-elevating effects of these drugs may also include the aggression-enhancing effects that are seen in animals under certain conditions and that may be relevant to the occasional incidence of human violence after psychomotor stimulants. More important, however, are the psychopathic conditions that precede chronic amphetamine or cocaine use in predicting violent outbursts. Whether the paranoid psychosis due to amphetamine or cocaine use represents the causative condition for occasional violent behavior or the psychopathology preceding drug use is unclear at present. The relatively infrequent occurrences of violent activities in stimulant abusers appear to result from brain dopamine changes that are counteracted by treatment with antipsychotic drugs.
Norepinephrine
Behavioral events involving intense affect are accompanied by adrenergic activity, in both the peripheral and the central nervous system. For several decades, the adrenergic contribution to the "flight-fight" syndrome in the form of increased sympathetic innervation as well as adrenal output has been well established. More recently, large changes in noradrenergic neurotransmitter activity in limbic, diencephalic, and mesencephalic regions, while preparing for, executing, and recovering from highly arousing activities—among them aggressive and violent behavior—have been documented. So far, in neither animal nor human studies have noradrenergic "markers" emerged that selectively identify the propensity to engage in an aggressive or violent act. Rather, noradrenergic activity, either measured in the form of metabolite levels in a bodily fluid or indirectly assessed in a sympathetically innervated end organ, is correlated with the level of general arousal, degree of behavioral exertion and activation, and either positive or negative affect, but not with a specific behavior or mood change such as a violent act.
The most significant development during the past dozen years in applying noradrenergic drugs in the management and treatment of retarded, schizophrenic, or autistic patients with a high rate of
