Violent behavior

Inexperienced users or individuals who are exposed to the drug unexpectedly (e.g., who unknowingly consume PCP-adulterated cannabis) may develop severe anxiety and panic because of the intensity and variety of symptoms. Perceptual distortions have sometimes led to extremely violent behavior, accidents, or self-damaging acts. An especially high risk of violent behavior has been reported in acutely intoxicated PCP users who have a history of psychiatric problems. Intoxication with doses in excess of 150 mg may lead to convulsions, coma, and death from respiratory arrest. Other complications include hypertensive crisis, intracerebral hemorrhage, and renal failure (Table 6-5). 

The decline in Los Angeles between 1983 and 1984 cannot immediately be interpreted as a decline in PCP use for that city. In 1981, during an investigation of PCP trends in Los Angeles, it was discovered that many PCP emergencies were diverted to psychiatric units, better equipped to handle the violent behavior sometimes accompanying PCP reactions. These psychiatric units were not participating in the DAWN network at that time (Kozel and Husson 1981). It is possible that similar systemic problems may have occurred in 1984. 

PCP is used by persons who tend to be multiple drug users. PCP is one of the more common drugs found in arrestee populations, although its prevalence varies considerably by jurisdiction. An unknown, but probably very small percentage of users suffer extreme PCP-induced intoxication and disorientation and commit bizarre, often violent acts. Much more research is needed to identify the extent of these problems in users, and to learn how personality, other drug use, and the quality and quantity of PCP ingested contribute to the occurrence of violent behavior. (Wish and Johnson, in press)... 

Another implication of the large numbers of arrestees who use PCP is that only a small percentage of users probably experience the bizarre, violent behavior that is often attributed to PCP. If more than one or two percent of the arrestees in New York City and Washington, D.C. were to experi ence violent psychotic-like behavior when they use PCP, the police and treatment resources in these cities would be overburdened by the problem. Furthermore, these estimates do not include the many users of PCP who are never arrested. 

Behavior. Some patients with PCP toxicity display inappropriate behavior. Behavioral effects include muteness, staring, violence, and agitation. Violent behavior occurred in 35 percent of people with PCP intoxication who were examined on the prison wards of the LAC/USC Medical Center (McCarron et al. 1981a). 

In adult patients, the manifestations of PCP use can be grouped into nine clinical patterns of intoxication. Four of these are called major patterns because they may be associated with severe toxicity and often necessitate hospitalization. Patients with major patterns are usually unpredictable symptoms wax and wane, and the patient may abruptly change from one pattern of intoxication to another. Five other symptom complexes are designated as minor patterns since toxicity is usually mild and of short duration. Major Patterns consist of coma, catatonic syndrome, toxic psychosis, and acute brain syndrome. Minor Patterns are lethargy, bizarre behavior, violent behavior, agitation, and euphoria (McCarron et al. 1981b). 

Violent behavior Alert ori ented Bizarre, vio 1ent or agitated... 

Long-term amphetamine abuse results in many damaging effects, not least of which is addiction. Chronic abusers exhibit symptoms that can include violent behavior, anxiety, confusion, and insomnia. They also can display a number of psychotic features, including paranoia, auditory hallucinations, mood disturbances, and delusions (for example, the sensation of insects creeping on the skin). The paranoia can result in homicidal as well as suicidal thoughts. 

Flomicides have been committed under the influence of LSD and other drugs of this type, although these agents are not intrinsically likely to unleash violent behavior. Rather, the disinhibiting effects may remove constraints or violence already present in an individual. I have encountered instances of persons accused of homicide who claimed that the crime was perpetrated under the influence of hallucinogens. Unfortunately, it is not possible to substantiate such claims. Some, however, strain one s credulity and suggest that this type of plea of diminished responsibility is often misused. 

In retrospect, Matthew s mother realizes that he was probably chemically sensitive at birth, but it was years before they understood the cause of his erratic, hyperactive, sometimes violent behavior. Because there seemed to be no rhyme or reason to his behaviors all that time, Matthew developed a poor self-image, impaired social skills, and a reputation for being difficult. 

Chronic use has been associated with an "amotivational syndrome" characterized by loss of interest in social activities, school, work, or other goal-directed activities. Cannabis use is cited as the cause of this phenomenon, but there is no evidence to support any causal relationship. There is evidence, however, that the symptoms of the "amotivational syndrome" are secondary to depression (Musty and Kraback 1995). In contrast to ethanol, there is no evidence to support that cannabis causes an increase in violent behavior (Murray 1986). However, cannabis use may be contraindicated in those with preexisting psychiatric disturbances such as bipolar disorder or schizophrenia. 

Suicidal Ideation (capsules/oral solution) Severe psychiatric adverse events including depression, psychoses, aggressive behavior, hallucinations, violent behavior (suicidal ideation, suicidal attempts, suicides) and rare instances of homicidal ideation have occurred during combination ribavirin capsulesZ/nfron A therapy, both in patients with and without a previous psychiatric disorder. 

CNS- Fatigue headache pseudotumor cerebri, including headache, visual disturbances, and papilledema dizziness drowsiness insomnia lethargy malaise nervousness paresthesias seizures stroke syncope weakness suicidal ideation suicide attempts suicide psychosis emotional instability aggression violent behaviors. Depression has occurred and has subsided with discontinuation of therapy and recurred upon reinstitution. 

Alvarez, K.M., Donohue, B., Kenny, M.C., Cavanagh, N. and Romero, V. (2005) The process and consequences of reporting child maltreatment a brief overview for professionals in the mental health field. Aggression and Violent Behavior 10, 311-331. 

Most studies of violent behavior in adults focus on inpatient or recently discharged patients. As a group,... 

Additional studies suggest relationships between diminished frontal lobe function and poorly modulated aggression. Using MRl, Raine et al., (2000) found an 11 % reduction in the prefrontal gray matter volume in 21 subjects with ASP, compared to 34 healthy controls, 26 substance abusers, and 21 psychiatric controls. Thus, it appears that ASP with violent behavior is associated with reduced frontal lobe volume. 

Apter, A., Gothelf, D., Orbach, L, Weizman, R., Ratzoni, G., Har-Even, D., and Tgano, S. (1995) Correlation of suicidal and violent behavior in different diagnosis categories in hospitalized adolescent patients. J Am Acad Child Adolesc Psychiatry 34 912-918. 

Linnoila, M., Virkkunen, M., Scheinin, M., Nuutila, A., Riman, R., and Goodwin, F.K. (1983) Low cerebrospinal fluid 5-hydroxyindoleacetic acid concentration differentiates impulsive from nonimpulsive violent behavior. Life Sci 33 2609-2614. 

Volkow, N.D. and Trancredi, L. (1987) Neural substrates of violent behavior a preliminary study with positron emission tomography. Br J Psychiatry 151 668-673. 

Although trazodone has not received an FDA indication for use in children and adolescents, it has enjoyed some success in the treatment of disruptive behavior disorders in this population. An aggressive 15-year-old male inpatient was treated with trazodone at a dosage of 200 mg/day, which resulted in decreased disruptive behavior. Following discharge from the hospital, trazodone was discontinued and the patient s violent behavior resumed. Upon return to his previous dose of 200 mg, the aggressive behavior again remitted (Fras,... 

Rasanen, P., Tiihonen, J., Isohanni, M., Rantakallio, P., Lehtonen, J., and Moring, J. (1998) Schizophrenia, alcohol abuse and violent behavior a 2-year followup study of an unselected birth cohort Schizophre Bull 24 437-441. 

Anabolic-androgenic steroids (AAS), which are analogs of the male hormone testosterone, are used among athletes and bodybuilders. AAS alter the hormonal systems of males and females, and induce many adverse effects. In addition to the sex-related changes, violent behavior and psychological dependence can also occur. The use of AAS in professional sports as well as in high school sports has aroused considerable attention. 

Violent behavior may have numerous causes, yet in many cases treatment must be initiated before an accurate diagnosis can be made. Nevertheless, a tentative diagnosis should be attempted. The most common causes of such behavior in emergency room settings include psychosis, personality disorder, and alcohol or drug intoxication or withdrawal. In medical or surgical wards, delirium is the more likely cause. 

The health effects of Prozac and other SSRIs have been debated since these drugs were made available to the public. Foremost among health concerns is whether SSRIs increase suicidal and violent behavior. Hundreds of lawsuits have been filed against Eli Lily alleging that Prozac was responsible for all types of destructive behavior. The vast majority of these cases... 

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