Use of sodium valproate in violent and aggressive behaviors: a critical review.

BACKGROUND: Valproate was initially introduced as an antiepileptic agent in 1967, but has been used over the years to treat a variety of psychiatric disorders. Its use in the treatment of patients exhibiting aggressive and violent behaviors has been reported in the literature as far back as 1988. However, these reports are uncontrolled, which is in marked contrast to the actual wide and established use of valproate for the treatment of aggressive behaviors. The aim of this report is to critically review the available data on valproate's use in nonbipolar patients with aggressive and violent behaviors. DATA SOURCES: The MEDLINE and PsycLIT databases were searched for all reports published from 1987-1998 containing the keywords valproate, the names of all commercial preparations, aggression, and violence. STUDY FINDINGS: Seventeen reports with a total of 164 patients were located. Ten of these were case reports with a total of 31 patients. Three were retrospective chart reviews with 83 patients, and 3 were open-label prospective studies with a total of 34 patients. No double-blind, placebo-controlled study could be found. An overall response rate of 77.1% was calculated when response was defined as a 50% reduction of target behavior. Most frequent diagnoses recorded were dementia, organic brain syndromes, and mental retardation. The antiaggressive response usually occurred in conjunction with other psychotropic medication. The dose and plasma valproate level required for response appeared to be the same as in the treatment of seizure disorders. DISCUSSION: While valproate's general antiaggressive effect is promising, in the absence of controlled data, conclusions are limited at this time. Specific recommendations for study design are given to obtain interpretable data for this indication.

At issue: speech fluency and schizophrenic negative signs.

The spontaneous speech of negative-syndrome schizophrenia patients is underproductive and contains many hesitations and pauses. Acoustic analysis of the patient's speech during interview reveals that the duration of pauses, independent of other linguistic or paralinguistic measures, correlates strongly with the clinician's impressions of the patient's flat affect and alogia. Pausing is less related to associality and other aspects of the negative syndrome. The hesitations appear to reflect a word-finding difficulty that, together with neuropsychological evidence of compromised performance on word fluency tasks, suggests a specific speech generation difficulty. The significant relationship between pausing and both flat affect and alogia suggests that the two negative signs share phenomenal and psychometric properties. The examination of speech generation mechanisms may provide an informative avenue for study of schizophrenic psychopathology. Acoustic analysis reveals processes that are not apparent to the clinician and may provide a useful basis for clinical assessments and research.