Dimensional treatment of aggression, impulsivity, and activation: A study on psychiatric inpatients

Introduction. Most psychotropic drugs are effective for several mental disorders, rather than for specific diagnoses. The dimensional approach to psychiatric nosology can explain the non-specificity of drug action, and it could usefully integrate the traditional categorical approach and may help optimize personalised psychiatric treatment. This study aimed at examining the use of antiepileptic drugs, particularly valproate, for the treatment of prominent aggression, impulsivity, and activation, within the conceptual framework of a “dimensional pharmacotherapy” strategy. Methods. This observational, naturalistic study included 846 adult psychiatric inpatients. Within 48 hours from admission and then again at discharge, each patient was administered the Brief Psychiatric Rating Scale (BPRS) and the SVARAD scale for rapid dimensional assessment. Results. We found a statistically significant association between the prescription of an antiepileptic drug (valproate in the vast majority of cases) and the presence of high levels of aggression, impulsivity, and activation. In patients with high levels of these psychopathological dimensions, the prescription of an antiepileptic drug was significantly associated with a greater decrease in BPRS total score from admission to discharge. This finding remained significant after the exclusion of patients experiencing a manic or mixed episode. Conclusions. Although methodological limitations dictate caution in interpreting our results, these preliminary findings suggest that a “dimensional pharmacotherapy” strategy (i.e., selecting drugs based on neurobiological action rather than categorical diagnosis) for the treatment of aggression, impulsivity and activation is commonly used in daily practice and may lead to greater clinical improvement, in the absence of severe adverse effects.