Volavka J
Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York.
Postgrad Med. 1988 Feb 29;Spec No:163-8.
Persistent aggressive behavior may develop in patients with brain disorders of various types, including seizure disorders, mental retardation, metabolic disorders, head injury, and in some instances schizophrenia. Although a neurochemical basis for aggression in these cases is unclear, a hyperadrenergic state is considered to be one possibility. This has led to the hypothesis that beta blockers may be useful in the control of aggression. The original assumption was that the site of antiaggressive action of beta blockers is in the brain. However, the antiaggressive efficacy of nadolol, which does not cross the blood-brain barrier to any great extent, suggests a peripheral site or sites. A review of several studies in which both old and young aggressive patients with various organic brain disorders received propranolol showed that aggressive behavior was reduced in 75 (86%) of 87. These results are encouraging because none of the patients had responded to earlier drug treatment. However, with the exception of one study of nine patients, none of the studies were controlled for placebo effects and most were retrospective. Preliminary results suggest tentative guidelines for treatment of aggressive behavior with beta blockers. Further studies are needed, and these should use a prospective, longitudinal double-blind design; large enough patient samples to permit testing hypotheses about disease-specific or symptom-specific responses to beta blockers; and improved instruments for measuring and classifying aggression.
持续性攻击行为可能在患有各种脑部疾病的患者中出现，包括癫痫症、智力迟钝、代谢紊乱、头部受伤，以及在某些情况下的精神分裂症。虽然这些情况下攻击行为的神经化学基础尚不清楚，但高肾上腺素能状态被认为是一种可能性。这导致了一种假设，即β受体阻滞剂可能有助于控制攻击行为。最初的假设是β受体阻滞剂的抗攻击作用部位在大脑。然而，纳多洛尔在很大程度上不会穿过血脑屏障，但其抗攻击效果表明存在外周部位。对几项研究的综述显示，患有各种器质性脑部疾病的老年和年轻攻击行为患者接受了普萘洛尔治疗，其中87例中有75例（86%）的攻击行为有所减少。这些结果令人鼓舞，因为这些患者之前均未对药物治疗产生反应。然而，除了一项对9名患者的研究外，其他研究均未对安慰剂效应进行对照，且大多数研究都是回顾性的。初步结果为使用β受体阻滞剂治疗攻击行为提供了暂行指导方针。还需要进一步的研究，这些研究应采用前瞻性、纵向双盲设计；足够大的患者样本，以便能够检验关于对β受体阻滞剂的疾病特异性或症状特异性反应的假设；以及改进测量和分类攻击行为的工具。
