Divalproex in the treatment of impulsive aggression: efficacy in cluster B personality disorders.

Eric Hollander, Katherine A. Tracy, Alan C. Swann, Emil F. Coccaro, Susan L. McElroy, Patricia Wozniak, Kenneth W. Sommerville, Charles B. Nemeroff

Research output: Contribution to journalArticle

197 Citations (Scopus)

Abstract

Impulsive aggressive behavior is common in psychiatric disorders and accounts for significant morbidity and mortality. However, little systematic treatment data exist from placebo-controlled trials for this symptom domain. This was a multicenter, randomized, double-blind, placebo-controlled study in which outpatients with a score of > or =15 on the Aggression scale of the Overt Aggression Scale-Modified (OAS-M) and who fulfilled DSM-IV criteria for Cluster B personality disorder (n=96), intermittent explosive disorder (n=116), or post-traumatic stress disorder (n=34) were randomized to divalproex sodium or placebo for 12 weeks duration. Based on average OAS-M Aggression scores over the last 4 weeks of treatment, a treatment effect was not observed in the intent-to-treat data set (combined across the three psychiatric disorders), but was observed in both intent-to-treat and evaluable data sets for patients with Cluster B personality disorders. In the Cluster B evaluable data set, statistically significant treatment differences favoring divalproex were also observed for component items of the OAS-M Aggression score, including verbal assault and assault against objects, as well as OAS-M Irritability score, and Clinical Global Impression (CGI)-Severity at multiple time points throughout the study. No treatment group difference was noted for overall premature discontinuation rate; however, across psychiatric diagnoses, 21 (17%) patients in the divalproex group prematurely discontinued because of an adverse event, as compared to 4 (3%) patients in the placebo group (p <0.001). While a treatment effect was not observed when all diagnostic groups were combined, in a large subgroup of patients with Cluster B disorders, divalproex was superior to placebo in the treatment of impulsive aggression, irritability, and global severity.

Original languageEnglish (US)
Pages (from-to)1186-1197
Number of pages12
JournalNeuropsychopharmacology
Volume28
Issue number6
StatePublished - Jun 2003
Externally publishedYes

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Personality Disorders
Valproic Acid
Aggression
Placebos
Therapeutics
Psychiatry
Disruptive, Impulse Control, and Conduct Disorders
Impulsive Behavior
Post-Traumatic Stress Disorders
Mental Disorders
Diagnostic and Statistical Manual of Mental Disorders
Outpatients
Morbidity
Mortality

ASJC Scopus subject areas

  • Pharmacology

Cite this

Hollander, E., Tracy, K. A., Swann, A. C., Coccaro, E. F., McElroy, S. L., Wozniak, P., ... Nemeroff, C. B. (2003). Divalproex in the treatment of impulsive aggression: efficacy in cluster B personality disorders. Neuropsychopharmacology, 28(6), 1186-1197.

Divalproex in the treatment of impulsive aggression : efficacy in cluster B personality disorders. / Hollander, Eric; Tracy, Katherine A.; Swann, Alan C.; Coccaro, Emil F.; McElroy, Susan L.; Wozniak, Patricia; Sommerville, Kenneth W.; Nemeroff, Charles B.

In: Neuropsychopharmacology, Vol. 28, No. 6, 06.2003, p. 1186-1197.

Research output: Contribution to journalArticle

Hollander, E, Tracy, KA, Swann, AC, Coccaro, EF, McElroy, SL, Wozniak, P, Sommerville, KW & Nemeroff, CB 2003, 'Divalproex in the treatment of impulsive aggression: efficacy in cluster B personality disorders.', Neuropsychopharmacology, vol. 28, no. 6, pp. 1186-1197.
Hollander E, Tracy KA, Swann AC, Coccaro EF, McElroy SL, Wozniak P et al. Divalproex in the treatment of impulsive aggression: efficacy in cluster B personality disorders. Neuropsychopharmacology. 2003 Jun;28(6):1186-1197.
Hollander, Eric ; Tracy, Katherine A. ; Swann, Alan C. ; Coccaro, Emil F. ; McElroy, Susan L. ; Wozniak, Patricia ; Sommerville, Kenneth W. ; Nemeroff, Charles B. / Divalproex in the treatment of impulsive aggression : efficacy in cluster B personality disorders. In: Neuropsychopharmacology. 2003 ; Vol. 28, No. 6. pp. 1186-1197.
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