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首页> 外文期刊>The British journal of psychiatry : >Efficacy of mood stabilisers in the treatment of impulsive or repetitive aggression: systematic review and meta-analysis
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Efficacy of mood stabilisers in the treatment of impulsive or repetitive aggression: systematic review and meta-analysis

机译：情绪稳定剂在治疗冲动性或重复性侵略中的功效：系统评价和荟萃分析

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Background Individuals with repetitive or impulsive aggression in the absence of other disorders may be diagnosed with intermittent explosive disorder according to DSMa€“IV, but no such diagnostic category exists in ICDa€“10. Mood stabilisers are often used off-license for the treatment of aggression associated with a variety of psychiatric conditions, but their efficacy in these and in idiopathic aggression is not known. Aims To summarise and evaluate the evidence for the efficacy of mood stabilisers (anticonvulsants/lithium) in the treatment of impulsive or repetitive aggression in adults. Method A meta-analysis of randomised controlled trials that compared a mood stabiliser with placebo in adults without intellectual disability, organic brain disorder or psychotic illness, identified as exhibiting repetitive or impulsive aggression. Results Ten eligible trials (489 participants) were identified A pooled analysis showed an overall significant reduction in the frequency/severity of aggressive behaviour (standardised mean difference (SMD) = a€“1.02, 95% CI a€“ 1.54 to a€“0.50), although heterogeneity was high ( I 2 = 84.7%). When analysed by drug type, significant effects were found in the pooled analysis of three phenytoin trials (SMD = a€“ 1.34, 95% CI a€“2.16 to a€“0.52), one lithium trial (SMD = a€“ 0.81, 95% CI a€“1.35 to a€“0.28), and two oxcarbazepine/carbamazepine trials (SMD = a€“1.20, 95% CI a€“1.83 to a€“ 0.56). However, when the results of only those studies that had a low risk of bias were pooled (347 participants), there was no significant reduction in aggression (SMD = a€“0.28, 95% CI a€“0.73 to 0.17, I 2 = 71.4%). Conclusions There is evidence that mood stabilisers as a group are significantly better than placebo in reducing aggressive behaviour, but not all mood stabilisers appear to share this effect. There is evidence of efficacy for carbamazepine/oxcarbazepine, phenytoin and lithium. Many studies, however, were at risk of bias and so further randomised controlled trials are recommended.
机译：背景根据DSMA IV，可以在没有其他障碍的情况下进行反复性或冲动性攻击的个人被诊断为间歇性爆发性疾患，但ICDa 10中不存在此类诊断类别。情绪稳定剂通常被许可用于治疗与各种精神病相关的侵略性，但在这些疾病和特发性侵略中的疗效尚不明确。目的总结和评估情绪稳定剂（抗惊厥药/锂）在成人冲动或重复性侵略治疗中功效的证据。方法对一项随机对照试验的荟萃分析，该试验对没有智力障碍，器质性脑疾病或精神病的成年人中的情绪稳定剂与安慰剂进行了比较，确定其表现出重复性或冲动性攻击。结果确定了十项合格试验（489名参与者）。汇总分析显示，攻击行为的频率/严重程度总体上显着降低（标准平均差异（SMD）= a“ 1.02，95％CI a”“ 1.54至a”） 0.50），尽管异质性很高（I 2 = 84.7％）。当按药物类型进行分析时，在三项苯妥英钠试验（SMD = 1.34，95％CI≤2.16至a'0.52）的汇总分析中发现了显着效果，一项锂试验（SMD = 0.81） ，95％CI约为1.35至1.28到0.28）和两次奥卡西平/卡马西平试验（SMD = 1.20，95％CI约为1.83至0.56）。但是，当仅收集那些偏倚风险较低的研究的结果（347名参与者）时，攻击性没有显着降低（SMD = 0.28，95％CI 0.73至0.17，I 2）。 = 71.4％）。结论有证据表明，情绪稳定剂作为一个整体在减少侵略性行为方面比安慰剂好得多，但并非所有情绪稳定剂似乎都具有这种作用。有证据表明卡马西平/奥卡西平，苯妥英钠和锂具有疗效。但是，许多研究都有偏见的风险，因此建议进行进一步的随机对照试验。

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