Overview

In this book, we will discuss what is known regarding individuals who are violent or aggressive, including neural circuitry and possible genetic influences underlying violent and aggressive behavior as well as the evidence- and practice-based treatment strategies that may reduce such behavior. Given the fact that mental illness may increase the risk of violent or aggressive behavior, yet with only a small subset of mentally ill patients exhibiting this disturbing behavior, it is crucial that we are able to predict which individuals are more likely to be violent or aggressive and take measures to prevent violent acts.

Target Audience

This activity has been developed for prescribers specializing in psychiatry. There are no prerequisites. All other health care providers interested in psychopharmacology are welcome for advanced study, especially primary care physicians, nurse practitioners, psychologists, and pharmacists.

Statement of Need

The following unmet needs and professional practice gaps regarding violence were revealed through new medical knowledge and following a critical analysis of activity feedback, expert faculty assessment, and a literature review:

• • Increasingly, pressure is being put on mental health professionals to better predict which individuals are at the greatest risk for committing acts of violence

• • There is also great demand for clinicians to employ treatment strategies aimed at preventing violent and aggressive behavior

• • There is little evidence-based psychopharmacology for the management of treatment-resistant aggressive symptoms in individuals with violence and assaultiveness other than clozapine

• • Standard doses of all antipsychotics target 60-80% occupancy of D2 receptors, but this may principally treat positive symptoms and be effective only in individuals who are neither treatment resistant nor violent; very highdose antipsychotic treatment to target >80% D2 receptor occupancy may be justified in individual cases

To help address clinician performance gaps with respect to understanding and treating violent or aggressive behavior, quality improvement efforts need to provide education regarding 1) the epidemiology, neurobiology, and genetics of violence, impulsivity, and aggression and 2) strategies to address violent, impulsive, and aggressive behavior in patients with mental illness.

Learning Objectives

After completing this activity, participants should be better able to:

• • Understand the epidemiology and heterogeneity of violence and aggression