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      Pharmacotherapy of Primary Impulsive Aggression in Violent Criminal Offenders

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          Abstract

          Primary impulsive aggression (PIA) can be implicated as a common factor that results in an arrest, disciplinary, and restraint measures during confinement, and criminal recidivism after release. Evidence suggests that anti-impulsive aggression agents (AIAAs) can diminish or prevent impulsive aggression even when occurring with personality pathology such as borderline or antisocial personality disorder (ASPD), common conditions in offender populations. A previous review identified agents that have been subjected to controlled drug trials of sufficient quality, and subsequently, a decisional algorithm was developed for selecting an AIAA for individuals with IA. This selection process began with the five agents that showed efficacy in two or more quality studies from the earlier review. Today, 8 years after the quality review study, the present authors undertook this follow-up literature review. The aims of the present review were to survey the literature to identify and assess: (1) drug trials of comparable quality published since the 2013 review, including trials of the previously identified AIAAs as well as trials of agents not included in the earlier review; (2) severity of aggressive outbursts; (3) the materiality of risks or side-effects that are associated with individual AIAAs as well as antipsychotic agents commonly used to control clinical aggression; (4) efficacy of these agents in special populations (e.g., females); and (5) cost and convenience of each agent. Improved pharmacotherapy of PIA by addressing risks, side effects and practicality as well as the efficacy of AIAAs, should promote the rehabilitation and reintegration of some pathologically aggressive offenders back into the community.

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          Classification for Effective Rehabilitation: Rediscovering Psychology

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            Rehabilitating criminal justice policy and practice.

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              Serious mental disorder in 23000 prisoners: a systematic review of 62 surveys.

              About 9 million people are imprisoned worldwide, but the number with serious mental disorders (psychosis, major depression, and antisocial personality disorder) is unknown. We did a systematic review of surveys on such disorders in general prison populations in western countries. We searched for psychiatric surveys that were based on interviews of unselected prison populations and included diagnoses of psychotic illnesses or major depression within the previous 6 months, or a history of any personality disorder. We did computer-assisted searches, scanned reference lists, searched journals, and corresponded with authors. We determined prevalence rates of serious mental disorders, sex, type of prisoner (detainee or sentenced inmate), and other characteristics. 62 surveys from 12 countries included 22790 prisoners (mean age 29 years, 18530 [81%] men, 2568 [26%] of 9776 were violent offenders). 3.7% of men (95% CI 3.3--4.1) had psychotic illnesses, 10% (9--11) major depression, and 65% (61--68) a personality disorder, including 47% (46--48) with antisocial personality disorder. 4.0% of women (3.2--5.1) had psychotic illnesses, 12% (11--14) major depression, and 42% (38--45) a personality disorder, including 21% (19--23) with antisocial personality disorder. Although there was substantial heterogeneity among studies (especially for antisocial personality disorder), only a small proportion was explained by differences in prevalence rates between detainees and sentenced inmates. Prisoners were several times more likely to have psychosis and major depression, and about ten times more likely to have antisocial personality disorder, than the general population. Worldwide, several million prisoners probably have serious mental disorders, but how well prison services are addressing these problems is not known.
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                Author and article information

                Contributors
                Journal
                Front Psychol
                Front Psychol
                Front. Psychol.
                Frontiers in Psychology
                Frontiers Media S.A.
                1664-1078
                16 December 2021
                2021
                : 12
                : 744061
                Affiliations
                [1] 1Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine , Saint Louis, MO, United States
                [2] 2Department of Medical Sciences, Surgery and Neurosciences, University of Siena , Siena, Italy
                [3] 3Hope and Healing Center and Institute , Houston, TX, United States
                Author notes

                Edited by: Eamonn Patrick Arble, Eastern Michigan University, United States

                Reviewed by: Märta Wallinius, Lund University, Sweden; Marijn Lijffijt, Baylor College of Medicine, United States

                *Correspondence: Alan R. Felthous, alan.felthous@ 123456health.slu.edu

                This article was submitted to Psychology for Clinical Settings, a section of the journal Frontiers in Psychology

                Article
                10.3389/fpsyg.2021.744061
                8716452
                34975633
                36bd3bea-fbb9-4111-b980-d3950728c090
                Copyright © 2021 Felthous, McCoy, Nassif, Duggirala, Kim, Carabellese and Stanford.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 19 July 2021
                : 02 November 2021
                Page count
                Figures: 0, Tables: 3, Equations: 0, References: 158, Pages: 16, Words: 15028
                Categories
                Psychology
                Review

                Clinical Psychology & Psychiatry
                primary impulsive aggression,pharmacotherapy,anti-impulsive aggression agents,criminal rehabilitation,conditional release,parole

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