￼Aggression is a serious medical problem in several neurologic and psychiatric patient groups. It can be a sign of an underlying nonpsychiatric medical disorder, or a symptom of a psychiatric or substance use problem. When faced with a patient who has aggressive behavior, the most important actions include ensuring safety of the patient and staff, followed closely by an evaluation of the cause of the aggression. In acute aggression, physical restraints may be needed for a short period until the physical examination and clinical assessment have been made. Pharmacotherapy for acute aggression involves sedating medications, which have risks in themselves and can make diagnosis difficult. A goal of pharmacotherapy for chronic aggression is to reduce aggression without producing significant sedation and other side effects. Although there are several controlled trials showing efficacy of several different classes of medications for treatment of chronic aggressive behavior, these studies have small sample sizes and none of these medications are approved by the FDA for this indication. All medications have side effects and a recent consensus statement supported the use of pharmacotherapy for aggression and agitation only after nonpharmacologic interventions had failed in patients with dementia because of the risk of side effects.106 Thus, nonpharmacologic interventions, such as reducing pain, improving sleep, and enhancing unit structure, should be applied before pharmacotherapy.
KEY WORDS: Aggression, pharmacotherapy, diagnosis, neurobiology