a Psychology and Behavioral Health , Children's National Medical Center , Washington , DC , USA.
b Research & Development , Supernus Pharmaceuticals, Inc. , Rockville , MD , USA.
Postgrad Med. 2019 Mar;131(2):129-137. doi: 10.1080/00325481.2019.1574401. Epub 2019 Feb 14.
Proper drug categorization enables clinicians to readily identify the agents most appropriate for patients in need. Currently, patients with maladaptive aggression do not all always fall into a single existing diagnostic or treatment category. Such is the case for those with impulsive aggression (IA). IA is an associated feature of numerous neuropsychiatric disorders, and can be described as eruptive, aggressive behavior or a 'short fuse'. Although agents from a broad spectrum of drug classes have been used to treat maladaptive aggression, few have been tested distinctly in patients with IA, and there is no drug specifically indicated by the US Food and Drug Administration (US FDA) for IA. Further, current treatments often fail to sufficiently treat IA symptomatology. These issues create an unclear and inadequate treatment path for patients. Here we will propose the establishment of a class of anti-maladaptive aggression agents to begin addressing this clinical issue. The development of such a class would unify the various drugs currently used to treat maladaptive aggression and streamline the treatment approach towards IA. As an important case example of the range of candidate drugs that could fit into a new anti-maladaptive aggression agent category, we will review an investigational IA pharmacotherapy. SPN-810 (extended-release molindone) is currently being investigated as a novel treatment for children with IA and ADHD. Based on these studies we will review how SPN-810 may be well suited for a new, anti-maladaptive aggression drug class and more precisely, a proposed subgroup of IA modulators. The goal of this review is to begin improving the identification of and therapeutic approach for maladaptive aggression as well as IA through more precise anti-maladaptive aggression agent categorization.
正确的药物分类可以使临床医生能够快速识别最适合患者需求的药物。目前，患有适应不良攻击行为的患者并不总是属于现有的单一诊断或治疗类别。冲动性攻击（IA）患者就是这种情况。IA 是许多神经精神疾病的一个相关特征，可以描述为爆发性、攻击性的行为或“短导火索”。虽然已经有许多药物类别中的药物被用于治疗适应不良的攻击行为，但很少有药物专门针对 IA 患者进行测试，并且美国食品和药物管理局（US FDA）也没有专门针对 IA 的药物。此外，目前的治疗方法往往无法充分治疗 IA 症状。这些问题为患者的治疗带来了不明确和不足的治疗路径。在这里，我们将提出建立一类抗适应不良攻击的药物来开始解决这一临床问题。开发这样一类药物将统一目前用于治疗适应不良攻击的各种药物，并使治疗 IA 的方法更加简化。作为一种可能适合新型抗适应不良攻击药物类别的候选药物的重要案例，我们将回顾一种用于治疗 IA 的新型药物。SPN-810（延胡索酸莫林酮缓释片）目前正在被研究用于治疗 IA 和 ADHD 儿童。基于这些研究，我们将回顾 SPN-810 如何适合新型抗适应不良攻击药物，更准确地说，是适合一种新的 IA 调节剂亚类。本综述的目的是通过更精确的抗适应不良攻击药物分类，开始改善适应不良攻击和 IA 的识别和治疗方法。
