Verbal aggression

Mood lability, inappropriate aggressive or sexual behavior, giddiness or verbally loud, impaired judgment possibly progressing to somnolence and coma as the blood level increases... 

Behavioral disturbances (physical and verbal aggression, motor hyperactivity, uncooperativeness, wandering, repetitive mannerisms and activities, and combativeness)... 

Methylphenidate (Ritalin). Methylphenidate was developed in the late 1950s and its first use was the treatment of what we now call ADHD. Since that time, it has also been approved for the treatment of narcolepsy. Its only other use is the treatment of severe refractory depression either in medically ill patients who need rapid clinical improvement or as an augmentation agent when added to other antidepressants. In the treatment of ADHD, methylphenidate not only improves attention but also reduces hyperactivity and impulsivity. Verbal and physical aggression typically decreases as well. 

Yudofsky, S.C., Silver, J.M., Jackson, W, Endicott, J., and Williams, D. (1986) The Overt Aggression Scale for the objective rating of verbal and physical aggression. Am J Psychiatry 143 35-39. 

Aggression may be acute or chronic, or verbal or physical. The target can be oneself, others, and/or property (see Table 50.1). 

Aggressive and hostile symptoms can overlap with positive symptoms but specifically emphasize problems in impulse control. They include overt hostility, such as verbal or physical abusiveness or even assault. Such symptoms also include self-injurious behaviors, including suicide and arson or other property damage. Other types of impulsiveness, such as sexual acting out, are also in this category of aggressive and hostile symptoms. 

Amphetamines have the potential to produce unprovoked, random, and often senseless violence, according to the World Health Organization (WHO). They are likely to demonstrate paranoia, antisocial behavior, become overly verbally and physically aggressive, and start fights over literally nothing. 

On the question of the relationship between verbal aggression and militant action in the Reformation debate see B. Scribner, Preconditions of Tolerance and Intolerance in Sixteenth-Century Germany, in O. P. Greel and B. Scribner, eds., Tolerance and Intolerance in the European Reformation (Cambridge, 1996), esp. 45-46. 

On April 21, 1989, Wise wrote an increased frequency report for the FDA on the subject of alprazolam and rage. Wise explained that the analysis was undertaken because over a 12 month period, Upjohn received six reports of rage, agitation, anger, aggression, and similar behavioral and emotional symptoms after exposures to alprazolam. All but one involved manifested or verbalized murderous impulses. According to Wise ... 

Two elderly patients with Alzheimer s disease and a mood disorder were treated with donepezil 5 mg/day and paroxetine 20 mg/day. One of them became agitated, confused, and aggressive, and donepezil was withdrawn after 8 days. On reintroduction of donepezil she again became rapidly confused, irritable, and verbally aggressive. In the other case, while the patient was taking paroxetine, donepezil 5 mg/day resulted in severe diarrhea, flatulence, and insomnia. The dosage of donepezil was reduced to 5 mg on alternate days, but the diarrhea and flatulence persisted. The symptoms resolved when donepezil was stopped. 

A 92-year-old man with a history of senile dementia of the Alzheimer type, glaucoma, and constipation took indometacin 25 mg for pseudogout. After six doses he became very agitated and confused and was physically and verbally aggressive. Indometacin was withdrawn and he recovered over 10 days with the help of halo-peridol 0.5 mg/day (558). 

Symptoms of the acute episode may include the following being out of touch with reality hallucinations (especially hearing voices) delusions (fixed false beliefs) ideas of influence (actions controlled by external influences) disconnected thought processes (loose associations) ambivalence (contradictory thoughts) flat, inappropriate, or labile affect autism (withdrawn and inwardly directed thinking) uncooperativeness, hostihty, and verbal or physical aggression impaired self-care skills and disturbed sleep and appetite. 

Because target symptoms of psychiatric disorders may respond differently in demented patients, a detailed list of symptoms to be treated should be documented in the pharmacotherapy plan to aid in monitoring. These could include, for example, striking at spouse because patient believes spouse is an impostor, verbal threats and refusal to allow clothes to be changed, and so on, as opposed to documenting vague symptoms such as aggression or delusions. To make an accurate assessment of depression, multiple symptoms (e.g., sleep, appetite, and activity and interest levels) need to be assessed in addition to the patient s stated mood. 

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