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Treating the violent patient with psychosis or impulsivity utilizing antipsychotic polypharmacy and high-dose monotherapy

Published online by Cambridge University Press:  14 August 2014

Debbi A. Morrissette  and
Stephen M. Stahl
Debbi A. Morrissette
Affiliation:
Neuroscience Education Institute, Carlsbad, CA, USA Department of Biology, Palomar College, San Marcos, CA, USA
Stephen M. Stahl*
Affiliation:
Neuroscience Education Institute, Carlsbad, CA, USA Department of Psychiatry, University of California, San Diego, USA Department of Psychiatry, University of Cambridge, UK California Department of State Hospitals
*
*Address for Correspondence: Stephen M. Stahl, 1930 Palomar Point Way, Suite 103, Carlsbad, CA 92002, USA. (E-mail: smstahl@neiglobal.com)
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Abstract

Insufficient treatment of psychosis often manifests as violent and aggressive behaviors that are dangerous to the patient and others, and that warrant treatment strategies which are not considered first-line, evidence-based practices. Such treatment strategies include both antipsychotic polypharmacy (simultaneous use of 2 antipsychotics) and high-dose antipsychotic monotherapy. Here we discuss the hypothesized neurobiological substrates of various types of violence and aggression, as well as providing arguments for the use of antipsychotic polypharmacy and high-dose monotherapy to target dysfunctional neurocircuitry in the subpopulation of patients that is treatment-resistant, violent, and aggressive. In this review, we focus primarily on the data supporting the use of second-generation, atypical antipsychotics both at high doses and in combination with other antipsychotics.

Keywords

atypicalpolypharmacyviolencemonotherapyaggressiontreatment-resistant
Type
Review Articles
Information
CNS Spectrums , Volume 19 , Issue 5 , October 2014 , pp. 439 - 448
Copyright
© Cambridge University Press 2014 

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