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.
Publication types
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Research Support, Non-U.S. Gov't
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Review
MeSH terms
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Antipsychotic Agents / therapeutic use*
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Aripiprazole / therapeutic use
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Benzodiazepines / therapeutic use
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Brain / metabolism
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Clozapine / therapeutic use
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Dibenzocycloheptenes
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Drug Therapy, Combination
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Heterocyclic Compounds, 4 or More Rings / therapeutic use
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Humans
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Impulsive Behavior*
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Isoxazoles / therapeutic use
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Lurasidone Hydrochloride / therapeutic use
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Olanzapine
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Paliperidone Palmitate / therapeutic use
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Piperazines / therapeutic use
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Piperidines / therapeutic use
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Polypharmacy
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Psychotic Disorders / drug therapy*
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Psychotic Disorders / metabolism
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Psychotic Disorders / psychology
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Quetiapine Fumarate / therapeutic use
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Receptors, Dopamine D2 / metabolism
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Risperidone / therapeutic use
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Thiazoles / therapeutic use
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Violence / classification
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Violence / prevention & control*
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Violence / psychology
Substances
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Antipsychotic Agents
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DRD2 protein, human
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Dibenzocycloheptenes
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Heterocyclic Compounds, 4 or More Rings
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Isoxazoles
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Piperazines
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Piperidines
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Receptors, Dopamine D2
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Thiazoles
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Benzodiazepines
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Quetiapine Fumarate
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ziprasidone
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Aripiprazole
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Clozapine
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asenapine
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Risperidone
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Olanzapine
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Lurasidone Hydrochloride
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Paliperidone Palmitate
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iloperidone