Neuropsychiatry of aggression
Conditions affecting the central nervous system, such as trauma or degenerative illness, often lead to neurobehavioural disorders. One of the most difficult of these to treat is aggression. Outwardly directed aggression can be divided into two types—reactive and proactive—the first of which is less structured and generally presents with visible anger, while the latter is structured and premeditated. While there exists no specific diagnostic criteria for either type of aggression, the closest that exist are intermittent explosive disorder (IED) for the former and conduct disorder (CD), which has been known to evolve into personality disorders (PDs), for the latter. This chapter explores the relation between aggression and other neuropsychiatric conditions, beginning with its neurobiological underpinnings. It then describes assessment methods, such as the Behaviour itself, Medical/ organic issues, Person showing the behaviour, Psychiatric/psychological issues, and Social/ occupational/ personal issues (BMPPS) model, before discussing treatments, both pharmacological and non-pharmacological. For the former, the effectiveness of various medications is discussed, from antipsychotics to mood stabilizers.