Pharmacotherapy for aggressive and violent behaviour: A view of practical management from clinicians

Within psychiatric populations, when violent behaviour occurs it is generally at least partly attributable to the psychiatric condition. The treatment therefore most likely to be successful in modifying the violent behaviour is that most appropriate for the underlying condition, and much may be achieved in calming aggressive behaviour without using any medication at all. No drug is a specific ‘treatment’ for violence. In situations of acute crisis, however, short‐term control of violent behaviour is often achieved most speedily and effectively when medication is included in the treatment approach. The drugs best fitted for such purposes have calming qualities. Neuroleptics are generally among the first to be used, followed by barbiturates or benzodiazepines. The power of the way in which such drugs are administered; for example, in the timing, route of delivery or form of preparation is often underestimated. In particular, the potential value of depot neuroleptics of intermediate duration of action is discussed. Longer‐term control of violence term of such drugs as the mood stabiliser lithium, anticonvulsants (including carbarnazepine), other sedatives and beta blockers is also discussed.