Q: All of the following medications can be tried in a patient with Anti-Social Personality Disorder (ASPD), particularly with aggressive tendencies EXCEPT?
A) Risperidone
B) Quetiapine
D) Sertraline
D) Propranolol
E) Alprazolam
Answer: E
Patients with ASPD having aggressive tendencies may require medications. The first line of drugs is second-generation antipsychotic medications such as risperidone. Quetiapine has also been used with success. In case of failure with first-line agents, Selective serotonin reuptake inhibitors (SSRIs) can be tried, such as sertraline or fluoxetine.
Lithium has also been described for use in ASPD. Antiseizure medications like carbamazepine and phenytoin can be of value also. Clinicians have utilized other drugs, such as propranolol, buspirone, and trazadone, with success.
Benzodiazepines and opioids should not be used due to their high dependence issue as well as the high chance of paradoxical exacerbation of aggressive outbursts.
#psychiatry
#pharmacology
References:
1. Khalifa NR, Gibbon S, Völlm BA, et al. Pharmacological interventions for antisocial personality disorder. Cochrane Database Syst Rev 2020; 9:CD007667.
2. Hirose S. Effective treatment of aggression and impulsivity in antisocial personality disorder with risperidone. Psychiatry Clin Neurosci. 2001 Apr;55(2):161-2. doi: 10.1046/j.1440-1819.2001.00805.x. PMID: 11285097.
3. Cowdry RW, Gardner DL. Pharmacotherapy of borderline personality disorder. Alprazolam, carbamazepine, trifluoperazine, and tranylcypromine. Arch Gen Psychiatry 1988; 45:111.
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