The literature regarding the use of medication for impulsive aggression, both in a prison setting and outside of prison, is briefly reviewed. The rationale for using oxcarbazepine for impulsive aggression in prison is presented, focusing on the evidence(though limited) of efficacy, the lack of frequent significant side effects, and the cost/benefit ratio, compared with other options.
People who are excessively aggressive and impulsive may be more likely than others to be in prison. Some of these inmates respond to the traditional behavioral approaches of correctional institutions, learning sufficient self-control to manage satisfactorily in a prison environment, and some have psychiatric diagnoses, such as bipolar disorder or schizophrenia, that typically respond to standard treatments.
Others, however, can be difficult to treat and may be aggressive even in prison. There is no one Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnosis that applies to most of these patients. Some may have residual attention deficit/hyperactivity disorder (ADHD), and some may have psychiatric diagnoses such as borderline or antisocial personality disorders, intermittent explosive disorder, or impulse control disorder NOS, which do not have standard approved medication treatments. How best to treat such inmates is a matter of opinion, with little solid research available. There is no medication approved by the U.S. Food and Drug Administration for the treatment of impulsive aggression.
The literature categorizes aggression in various ways, but the most common distinction is between impulsive aggression and predatory aggression. Predatory aggression is seen in hunting (among animals) and may be related to the aggressive acts perpetrated by organized crime groups. The treatments that have been studied for aggression have primarily involved patients with impulsive aggression. In certain settings (e.g., gang warfare), impulsive aggression may be ego syntonic to the perpetrator, and he may not see it as a problem requiring medication. However, with increasing age and mounting difficulties attributable to aggressive behavior (in a prison setting), many individuals for whom impulsive aggression may have been ego syntonic in the past may want to reduce their aggressiveness.
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