Treatment for Intermittent Explosive Disorder (IED):
1. Pharmacotherapy:
Goal: Reduce aggression without sedation or affecting other behaviors.
Medications Used:
SSRIs (Selective Serotonin Reuptake Inhibitors):
Fluoxetine and sertraline have shown reductions in irritability and aggression in IED patients.
Fluoxetine demonstrated significant improvement, but full remission was achieved in less than half of patients.
Mood Stabilizers:
Lithium has been effective in reducing aggression, especially in adolescents, but has a narrow therapeutic window and side effects.
Anticonvulsants (Phenytoin, Valproic acid, Divalproex, Carbamazepine, Topiramate) have shown mixed results in reducing impulsive aggression.
Atypical Antipsychotics:
Lower doses of risperidone reduce aggression in children with disruptive behavior disorders and elderly patients with dementia.
Side Effects: Increased risk of sedation, weight gain, extrapyramidal symptoms, and higher mortality in dementia patients (black box warning).
Psychostimulants (e.g., Methylphenidate):
Effective for impulsive aggression in ADHD and conduct disorder but limited use outside these disorders due to abuse potential and risk of mania in bipolar patients.
2. Psychotherapy:
Cognitive-Behavioral Therapy (CBT) and contingency management show promise in reducing aggression.
Randomized controlled trials found that 12 weekly CBT sessions significantly reduced aggression, anger, and hostile thinking while improving anger control and quality of life.
Individual therapy was particularly effective in enhancing overall well-being.
