oa SA Pharmaceutical Journal - Evidence-based Pharmacy Practice (EBPP): suppressing aggression : review

Volume 77, Issue 2
  • ISSN : 2221-5875
  • E-ISSN: 2220-1017



Aggression is an antagonistic behaviour that includes hostile verbal, physical or sexual actions directed towards the self, others or objects. In neuropsychological terms, it is thought to arise when abnormalities of higher integrative functions in the cerebral cortex reduce cortical inhibitory influences, resulting in less inhibition and loss of control of violent ideation. Examples of such behaviour include swearing, shouting, throwing objects, hitting, picking, scratching and head banging. Aggression often occurs in association with agitation, where the patient has increased speech, movement, restlessness and anxiety.

Agitated, impulsive and self-injurious behaviour can be precipitated by anxiety secondary to medical conditions such as hyperthyroidism, hypoglycaemia and shortness of breath; undertreated pain; and delirium secondary to anticholinergic toxicity. In addition, environmental factors such as hyper-stimulating surroundings or excessively boring environs can trigger aggressive behaviour. Reduction of such antagonistic conduct can be effected by management of the underlying medical condition or social circumstance that triggered the hostile actions.
In contrast, unprovoked, impulsive aggressive behaviour which occurs in patients with central nervous system disorders usually requires treatment specifically to suppress the violent symptoms. Patients with neurological deficits such as traumatic head injury, mental retardation, seizure disorders and Alzheimer's-associated dementia can exhibit explosive agitation or aggression, which necessitates drug treatment. Such overt aggressive behaviour can also occur as a manifestation of psychiatric disorders such as depression, obsessive-compulsive disorder, personality disorder, attention deficit disorder and schizophrenia.

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