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Propranolol Treatment of Chronically Hospitalized Aggressive Patients

Received May 27, 1998; revised July 21, 1998; accepted August 13, 1998. From Lenox Hill Hospital, New York University School of Medicine, New York, New York; Baylor College of Medicine, Houston, Texas; and Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, New York. Address correspondence to Dr. Silver, Department of Psychiatry, Lenox Hill Hospital, 100 East 77th Street, New York, NY 10021–1883.

Violent behavior in psychiatric patients may result in long-term hospitalization. There is no FDA-approved psychopharmacologic treatment for aggression. In this study, 20 chronically aggressive hospitalized patients were administered 1 week of placebo followed by an open trial of increasing doses of propranolol. Patients who had an equivocal or definite clinical response were entered into an open add-on double-blind discontinuation study phase. Aggressive behavior was objectively documented throughout the study. After the open phase of the study, 7 patients had a greater than 50% decrease in aggressive behavior. Four patients entered the double-blind discontinuation phase. The clinical course of 3 of those patients was consistent with the positive response to propranolol. The results of this study are consistent with a therapeutic effect of propranolol in some patients with aggressive behavior. Further studies are indicated.

Key Words: Aggression • Propranolol • Beta-Blockers

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