Psychopharmacology of the Rage Attack Phenomenon in a Child with Obsessive Compulsive Disorder

Barbara J. Coffey, MD, MS, University of Miami, Miller School of Medicine, 1120 NW 14th Street, Miami, FL 33136, E-mail: Bjc134@miami.edu Chief Complaint and Presenting Problem M. was a 13-year-old boy with recently diagnosed obsessive compulsive disorder (OCD) and attention-deficit/hyperactivity disorder (ADHD) referred for increasing frequency and intensity of rage attacks and homicidal ideation directed toward his mother. According to mother, onset of these symptoms occurred 6 months before admission, and they had been increasing dramatically in frequency, intensity, and duration during the past month. After starting fluoxetine, the child and adolescent psychiatrist questioned the possibility of selective serotonin reuptake inhibitor (SSRI)-induced mania, given increased aggression and decreased sleep. [...]when safety concerns become significant they may impact family accommodation patterns.