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Aggressive behavior and opportunities to purchase drugs.

Robins, Kellam, and others found robust evidence linking youthful aggression and deviance to later illicit drug use. Some investigators favor the interpretation that drug use is just one manifestation or complication of a more general problem behavior syndrome or conduct disorder. In this work, we test the complementary hypothesis that aggressive youth are more likely to be approached with offers to buy drugs, and found the most aggressive youths were about five times more likely to be offered drugs for purchase. However, this association was much attenuated when levels of delinquency were taken into account. In this respect, delinquent rather than aggressive behavior might be more salient. This study's evidence does not contradict previous problem behavior theories, but rather prompts new ideas about how aggression, delinquency, and drug use might be linked. One testable hypothesis is that youths with both aggression and delinquency are more likely to enter microenvironments where drug dealing is more prevalent. Or, their observable behaviors or physical appearance might function as signs of apparent willingness to try drugs. These results add to our understanding of links between aggression, delinquency, and drug use, and introduce a new line of epidemiological inquiry focused upon drug purchase opportunities.

Adolescent↗

Antisocial personality disorder and aggression in recently abstinent cocaine dependent subjects.

To study the relationship between cocaine abstinence symptoms, personality, and aggression, we used the Point Subtraction Aggression Paradigm (PSAP) to measure aggression in 18 subjects admitted for the treatment of cocaine dependence. Eight subjects met criteria for antisocial personality disorder (ASPD). There was a significant correlation between presence of ASPD and frequency of aggressive responding by stepwise multiple regression. When presence of ASPD was factored out of the correlations, there was no significant relationship between aggressive responding and cocaine craving, withdrawal symptoms, amount of cocaine used, or length of time since use. These preliminary results suggest that in cocaine dependent individuals seeking treatment, current aggression is most dependent on the individual's previous aggressive behavior.

Adult↗

Relationships between aggressive behavior in cognitively impaired nursing home residents and use of restraints, psychoactive drugs, and secured units.

This study examined relationships between aggressive behavior in cognitively impaired nursing home residents and physical restraints, psychoactive drugs, and placement on a secured unit. Data were obtained from 116 residents who were consistently aggressive as measured by the Ryden Aggression Scale 2. Subjects averaged 9.5 aggressive behaviors per day. Forty-seven percent of subjects were restrained, and 62% were regularly receiving psychoactive drugs. Use of restraints, antipsychotics, and placement on a secured unit were all significantly related to increased physical aggression scores. Four variables accounted for 23% of the variance in physical aggression scores: location on a secured unit, not receiving an antidepressant, being restrained, and number of psychotropic and/or anxiolytic medications administered. Significantly lower physical aggression scores were noted for subjects receiving antidepressants.

Aged↗

The relation of aggression, hostility, and anger to lipopolysaccharide-stimulated tumor necrosis factor (TNF)-alpha by blood monocytes from normal men.

Aggression, hostility, and anger significantly predict morbidity and mortality from atherosclerotic cardiovascular disease (ACVD). ACVD is believed to be an inflammatory disease characterized by increased expression of a number of proinflammatory cytokines, such as tumor necrosis factor (TNF)-alpha. This study examined the relation of aggression, hostility, and anger to monocyte-associated TNF-alpha expression following lipopolysaccharide (LPS) stimulation. Participants were 62 healthy, non-smoking men (aged 18-45 years). Hostility, anger, verbal, and physical aggression were assessed using the Buss-Perry aggression questionnaire (BPAQ). LPS-stimulated TNF-alpha expression was determined using dual-color flow cytometry gating for CD14(+) cells. After controlling for age, race, education, and alcohol use, scores on the hostility (p=.013), physical aggression (p=.010), and verbal aggression (p=.034) subscales, and the total score (p=.007) on the BPAQ were positively associated with LPS-stimulated TNF-alpha expression. The results suggest that hostility and aggression are associated with an increased expression of TNF-alpha, a cytokine implicated in ACVD.

Adolescent↗

Soles of the Feet: a mindfulness-based self-control intervention for aggression by an individual with mild mental retardation and mental illness.

Uncontrolled low frequency, high intensity aggressive behavior is often a barrier to community living for individuals with developmental disabilities. Aggressive behaviors are typically treated with psychotropic medication, behavioral interventions or their combination; but often the behaviors persist at a level that is problematic for the individual as well as care providers. We developed a mindfulness-based, self-control strategy for an adult with mental retardation and mental illness whose aggression had precluded successful community placement. He was taught a simple meditation technique that required him to shift his attention and awareness from the anger-producing situation to a neutral point on his body, the soles of his feet. After practice he applied this technique fairly consistently in situations that would normally have elicited an aggressive response from him. The data show that he increased self-control over his aggressive behaviors, met the community provider's requirement for 6 months of aggression-free behavior in the inpatient facility before being transitioned to the community, and then successfully lived in the community without readmission to a facility. No aggressive behavior was seen during the 1-year follow-up after his community placement. Mindfulness-based intervention may offer a viable alternative to traditional interventions currently being used to treat behavioral challenges in children and adults with mild mental retardation.

Adult↗

Central serotonergic activity is related to the aggressive behaviors of Alzheimer's disease.

The clinical correlates of reduced serotonin (5-HT) in Alzheimer's disease (AD) remain unknown. The hypothesis of this study was that altered central serotonergic activity is related to aggression in AD. Twenty-two institutionalized, nondepressed elderly (12 M/10 F, mean age +/- SD: 82.2 +/- 6.4) with probable AD, severe cognitive impairment (MMSE = 4.1 +/- 4.7) and significant behavioral disturbance (Neuropsychiatric Inventory (NPI) score > or = 8) were studied. The prolactin (PRL) response to d,l-fenfluramine (60 mg p.o.) was used as an index of central serotonergic function. The NPI aggression score, NPI irritability score, and Behavioral Pathology in AD aggression score were positively correlated to prolactin concentrations following fenfluramine challenge (r(S) =.61, p =.003; r(S) =.53, p =.012; and r(S) =.47, p =.029 respectively). In addition, aggressive patients showed a greater mean PRL increase (% baseline) (215 +/- 60, n = 11) than nonaggressive subjects (123 +/- 54, n = 11) (p =.01, 2-tailed t-test). The change in PRL concentration depended on level of cognitive impairment (p =.0004) and the gender x aggression interaction (p =.015) with the overall regression model accounting for 74% of the variance (r = 0.86, F = 11.9, p =.0001). Female aggressive subjects with less cognitive impairment had the largest response to fenfluramine challenge. These results suggest a complex link between aggression in AD and central serotonergic dysfunction having interactions with gender and cognitive impairment.

Aged↗

Effect of clozapine on physical and verbal aggression.

OBJECTIVE: The hypothesis that clozapine reduced serious physically and verbally aggressive behavior of persons with schizophrenia whose symptoms did not respond to typical neuroleptic treatment was tested. METHOD: Incident reports of aggression and restraint of 75 such inpatients were reviewed for 3 months before clozapine treatment and for 6 months of clozapine treatment. BPRS scores were also examined. Twenty-eight patients with no incidents were removed from study. RESULTS: There were significantly fewer incidents of physical aggression per month per patient on clozapine than before clozapine (mean +/- S.D. = 0.13 +/- 0.25 vs. 0.54 +/- 0.93; t = 3.4, df = 46, p < 0.002) and a similar decline in verbal aggression (0.21 +/- 0.31 vs. 0.73 +/- 0.83; t = 4.3, df = 46, p < 0.000). On clozapine, 49% (n = 23) of patients had fewer incidents of physical aggression, 36% (n = 17) showed no change and 15% (n = 7) showed more. Seventy percent (n = 33) of patients had fewer incidents of verbal aggression, 4% (n = 2) showed no change and 25% (n = 12) had more. During the 3 months before clozapine, 14 patients (30%) were restrained a total of 40 times. During the first 6 months of clozapine treatment, three patients (6%) were restrained a total of six times. There were significant decreases in BPRS hostility, positive, negative and psychosis scores. CONCLUSION: Clozapine appears to reduce serious aggression among some patients.

Adult↗

Family and personal characteristics of aggressive Nigerian boys: differences from and similarities with Western findings.

PURPOSE: To identify the family and child determinants of aggressive behaviour in Nigerian elementary school boys and to compare the findings with previous ones from Western studies. METHODS: Forty-seven aggressive boys from four elementary schools in Lagos, Nigeria were compared with 47 matched pro-social boys. Teacher rating and peer nomination were combined to select subjects. The subjects and their parents were given structured questionnaires to obtain information on possible risk factors for aggression. RESULTS: Compared with pro-social boys, it was found that significantly more aggressive boys came from polygamous families and crowded homes, had more siblings, received less parental affection, were more physically punished, less supervised at home, witnessed more domestic conflicts, did poorly at school, had poorer verbal intelligence and attributed malice more readily than pro-social boys. Logistic regression indicated that the independent family predictors of aggression were crowding, little paternal affection, and corporal punishment. The independent child predictors were biased attribution and poor school achievement. Corporal punishment at school was also an independent predictor of aggression. CONCLUSIONS: The family and child determinants of aggressive behaviour in Nigeria are similar to those found in Western studies except for the small contribution of family instability and overwhelming influence of corporal punishment in our sample. Models of intervention developed in the West may therefore be cautiously applied to Nigerian children.

Aggression↗

Social behaviour, stress and susceptibility to infection in house mice (Mus musculus): effects of duration of grouping and aggressive behaviour prior to infection on susceptibility to Babesia microti.

Unrelated and initially unfamiliar male CFLP mice, maintained for different periods in groups of 6, differed in both their rate of clearance of Babesia microti and the time taken to reach peak parasitaemia in relation to their aggressive behaviour within groups prior to infection. Males maintained in groups for shorter periods and showing more aggression within their group were slower to clear infection and males showing more marked external evidence of aggressive interaction reached a peak of parasitaemia sooner. Serum IgG and corticosterone analyses were consistent with increased aggression causing stress-induced immunodepression but relationships with aggression and social status were not simple. Males showing more aggression tended to enter their groups with higher levels of corticosterone and, to a lesser extent, reduced levels of IgG compared with other mice. The results thus suggest that increased susceptibility to disease may be a cost to males aggressively maintaining high social status.

Aggression↗

Developmental effects of early immune stress on aggressive, socially reactive, and inhibited behaviors.

The origins of individual differences in social development are examined in relation to early stress (immune challenge) and social milieu (maternal behavior) in a genetic-developmental analysis using an animal model. Neonatal male mice (5 or 6 days of age) from two lines of mice selectively bred for high versus low levels of inter-male aggressive behavior received a standard immune challenge (i.p. injections of 0.05 mg/kg endotoxin or saline). Animals were reared by their line-specific biological dam or by a foster dam from a line bred without selection. Adult levels of social behaviors were assessed in a dyadic test (age 45-50 days). Mice from the high-aggressive line show more developmental sensitivity to immune challenge than mice from the low-aggressive line, and line differences persist regardless of the early maternal environment. As adults, endotoxin-treated mice from the high-aggressive line have lower levels of aggressive behavior, longer latency to attack, and higher rates of socially reactive and inhibited behaviors compared to saline controls. Developmental effects of endotoxin in the low-aggressive line are minimal: endotoxin increases socially reactive behaviors, compared to saline controls, but only for mice reared by their biological dams. Rearing by foster dams increases social exploration in the low-aggressive line. The findings raise novel questions regarding the openness of behavioral systems to effects of nonobvious but omnipresent features of the environment, such as antigenic load, how these effects are integrated to affect social development and psychopathology, and the nature of intrinsic factors that contribute to individual differences in sensitivity to early stressors.

Aggression↗

Links between marital and parent-child interactions: moderating role of husband-to-wife aggression.

The present study examined how marital conflict may compromise parenting by identifying interdependencies across marital and parent-child subsystems in a sample of 86 two-parent families with a child aged 9-13. The study used direct observation of three family discussions to examine interdependencies across family subsystems. The study also assessed whether a history of husband-to-wife aggression strengthened interdependencies. Overall, families with husband-to-wife aggression showed a negative tone that pervaded throughout the family. Consistent with theories about physically aggressive men tending to withdraw from conflict, fathers who had engaged in husband-to-wife aggression showed an association between marital hostilities and lower levels of empathy toward their children. Consistent with stress theories, women who had been exposed to husband-to-wife aggression showed a link between marital hostilities and negative affect when interacting with their children. These findings illustrate how a history of exposure to marital aggression can create a family environment of multiple risks for children. For children in families with prior marital aggression, ongoing marital hostilities can be linked to the additional risk of erosions in parental support.

Adolescent↗

Developmental psychopathology and neurobiology of aggression.

The aim of this paper is to clarify how neural mechanisms at the molecular level, specifically the serotonergic (5-HT) system and the hypothalamic-pituitary-adrenal axis system (HPA) in conjunction with early life stress may contribute to the emergence of aggression, self-directed and otherwise, in borderline personality disorder (BPD). Chronic dysregulation of these biological systems, which function to regulate stress and emotion, may potentiate the development of impulsive aggression in borderline personality conditions. Our central premise in this paper is that brain development, stress regulation, and early pathonomic experience are interactive and cumulative in their mutual influence on the development of impulsive aggression in BPD. We review the parameters of impulsive aggression in BPD, followed by a discussion of the neurobiological and neuroendocrine correlates of impulsive aggression with and without BPD. We then focus on the developmental continuities in BPD with attention to brain maturation of 5-HT and HPA axis function during the life span and the influence of early adverse experiences on these systems. Finally, we comment on the data of the relative stability of aggression in BPD, adolescence as a developmental stage of potential vulnerability, and the course of aggressive behavior during the life span.

Adolescent↗

A positive view of self: risk or protection for aggressive children?

Children's ratings of competence and relationship quality were used to examine the association between idealized or inflated self-perceptions and level of aggression. Participants were 62 aggressive and 53 nonaggressive second and third graders. Ratings of competence were based on the Pictorial Scale of Perceived Competence and Social Acceptance for Young Children; ratings of relationship quality were drawn from the Social Support Appraisals Scale and the Network of Relationships Inventory. External ratings of competence and relationship quality were obtained from mothers, teachers, and peers. Compared to children who were nonaggressive, aggressive children were more likely to rate personal competence and relationship quality in a perfect or idealized manner and to show less differentiation in their ratings of competence and relationship quality. Aggressive children's self-rated competence and relationship quality were also inflated relative to the ratings made by others, whereas the self-ratings of nonaggressive children tended to be underestimates of their functioning. The tendency for aggressive children to idealize and to inflate ratings of competence and relationship quality was associated with higher levels of aggression. For aggressive children, a highly positive self-view is construed--not as a protective factor or measurement error--but as a defensive posture that places the child at added risk and that impedes the progress of psychosocial interventions.

Aggression↗

Distorted perceptions in dyadic interactions of aggressive and nonaggressive boys: effects of prior expectations, context, and boys' age.

This study examined distorted self- and peer perceptions in aggressive and nonaggressive boys at preadolescent and early adolescent age levels. Subjects completed semantic differential ratings of themselves and of their peer partners following two brief dyadic discussion tasks with competitive inductions and a game-playing task with a cooperative induction. Subjects also rated their expectations for self- and peer behavior prior to the two competitive interaction tasks. Research assistants later rated videotapes of the interactions. Aggressive boys had more distorted perceptions of dyadic behavior as they overperceived aggression in their partners and underperceived their own aggressiveness. These distorted perceptions of aggression carried over for aggressive boys into the third interaction task with a cooperative induction, indicating these boys' difficulty in modulating these perceptions when the overt demand for conflict is no longer present in the situation. Results also indicated that aggressive boys' perceptions of their own behavior after the first interaction task is substantially affected by their prior expectations, in comparison to nonaggressive boys who rely more on their actual behavior to form their perceptions.

Adolescent↗

Characteristics of aggressive subjects in Australian (Melbourne) nursing homes.

BACKGROUND: Aggressive behavior is common in nursing homes for the elderly. It causes distress to carers and can lead to hospitalization, overmedication, and physical restraint. METHOD: A 6-month prospective study examining the characteristics of aggressive subjects in 11 nursing homes in Melbourne using validated, reliable instruments. RESULTS: During the study, 121 and 143 subjects were rated aggressive on the Rating Scale for Aggressive Behavior in the Elderly and the Staff Observation Aggression Scale, respectively. Aggressive behavior was associated with younger age, men, subsequent mortality, and prescription of psychotropic drugs including neuroleptics, antidepressants, and benzodiazepines. CONCLUSIONS: Educational programs in the use of psychotropic drugs directed at staff involved in the care of nursing home residents may be of value because these drugs have modest efficacy, have significant side effects, and may simply sedate the patient rather than treat aggressive behavior.

Aged↗

Agitation and aggressiveness among the elderly population living in nursing or retirement homes in France.

The aim of this study was to describe the epidemiological features of agitation and aggressiveness in elderly individuals living in French nursing and retirement homes in the year 2000. Data were collected on the type, time of onset, and duration of symptoms, medical evaluation and treatment, and medical and psychiatric comorbidities of the elderly patients. The most frequently reported behavior was verbal aggressiveness and the least reported behavior was physical aggressiveness. A triggering factor initiating the symptoms of agitation or aggressiveness was reported in 61% of the cases. In 61% of the study population, there were several morbidities reported as caused by the agitated or aggressive behavior (anorexia, weight loss, dehydration). A specialist was consulted for nearly half of the agitated or aggressive patients. For 55% of the patients, a new medication regimen was started or the administration of previous medications was modified, the most frequently prescribed drugs being antipsychotics. The results of our study and others show that agitation and aggression have a substantial impact on the lives of the elderly population, as well as on the lives of their family members and caretakers.

Activities of Daily Living↗

Transdermal estrogen patches for aggressive behavior in male patients with dementia: a randomized, controlled trial.

OBJECTIVES: To investigate the efficacy and tolerability of transdermal estrogen patches for the adjunctive treatment of aggressive behavior in male patients with advanced dementia. METHODS: The study was designed as an 8-week, randomized, controlled trial in acute aged psychiatry inpatient units and specialized nursing homes in Melbourne, Australia, between 1998 and 1999. The participants were 27 men with established dementia, identified as displaying aggressive behavior not responding to treatment for at least 2 weeks prior to referral. The instruments used to measure aggressive behavior were the Rating Scale for Aggressive Behavior in the Elderly (RAGE), the Cornell Scale for Depression in Dementia (CSDD) and the Mini-mental State Examination (MMSE). Physical examination was performed and biochemistry and serum hormone concentrations were measured at baseline and at 8 weeks. Concomitant psychotropic medication use was recorded and analyzed. RESULTS: There was no significant difference in aggressive behavior at 8 weeks, but significant "rebound" in aggressive behavior (change in scores between week 8 and week 10, p < 0.009) and benzodiazepine use in the estrogen group (p < 0.03), following removal of the patches. Only behavioral items of the CSDD improved in the experimental group (p = 0.031). The use of patches was associated with a significant rise in serum estrogen (p < 0.001) but not with a significant decrease in serum testosterone (p = 0.077). There were no adverse effects associated with their use. CONCLUSIONS: The use of transdermal estrogen yielding up to 100 microg per day was not associated with discernable improvement in aggressive behavior in men with advanced dementia. Small subject numbers, multiple variables and a lack of statistical power impair interpretation of these results. However, the tolerability and apparent rebound effect on removal of patches indicate the need for larger studies in this area.

Activities of Daily Living↗

Psychopharmacologic strategies for the treatment of aggression in juveniles.

Maladaptive aggression in youth is one of the most common and troublesome reasons for referrals to child psychiatrists. It has a complex relationship with psychopathology. There are several syndromes, which are primary disturbances of clustered maladaptive aggression, most notably oppositional defiant disorder and conduct disorder. However, problems with aggression also appear in a wide range of other disturbances, such as bipolar disorder, posttraumatic stress disorder, and mood disorders. Additionally, aggression is normative, serves an adaptive purpose and can be situationally induced. These complexities need to be carefully addressed before targeting maladaptive aggression psychopharmacologically. We summarize the literature on the psychopharmacology of maladaptive aggression in youth, focusing on disorders without cognitive impairment. We delineate the subtypes of aggression which are most likely to respond to medication (reactive-affective-defensive-impulsive in their acute and chronic form) and conclude with a discussion of specific medication strategies which are supported by controlled clinical trials and clinical experience.

Adolescent↗