Morrissette Debbi A, Stahl Stephen M
1Neuroscience Education Institute,Carlsbad,CA,USA.
CNS Spectr. 2014 Oct;19(5):439-48. doi: 10.1017/S1092852914000388. Epub 2014 Aug 14.
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.
对精神病治疗不足往往表现为暴力和攻击性行为，这对患者自身及他人都很危险，因此需要采取一些并非一线循证治疗方法的治疗策略。这些治疗策略包括抗精神病药物联合治疗（同时使用两种抗精神病药物）和高剂量抗精神病药物单一疗法。在此，我们讨论各类暴力和攻击行为的假定神经生物学基础，并为使用抗精神病药物联合治疗和高剂量单一疗法以针对难治性、暴力及攻击性患者亚群中功能失调的神经回路提供依据。在本综述中，我们主要关注支持高剂量使用第二代非典型抗精神病药物以及将其与其他抗精神病药物联合使用的数据。
