The Pharmacotherapy of Impulsive Aggression in Psychopathic Disorders

This chapter focuses on the psychopharmacology of impulsive aggression, a topic often overlooked in otherwise comprehensive studies on the programmatic treatment of psychopathic disorders and factors favoring successful conditional release, probation, and parole, as well as institutional treatment and management of psychopathically disordered inmates. The Cochrane Database review on the pharmacotherapy of antisocial personality disorder concluded that the evidence is insufficient to permit conclusions about the use of pharmacological treatment of antisocial personality disorder. The chapter addresses in particular the pharmacotherapy of impulsive aggression, one of the most troublesome dimensions of psychopathic disorders. Impulsive aggression is a quick, strombolian overreaction, emotionally charged, typically with anger or rage, to a slight provocation with behavioral dyscontrol. A useful framework for the study and understanding of personality in general and impulsive aggression in particular is the multidimensional closed‐feedback system, which extends from birth and throughout life, proposed by Barratt.