Louis Bisono

Areas of expertise and specialization

Professional Memberships

• American Psychiatric Association  

Areas of research

By Dr. Louis Bisono, PA-C

Background

Intermittent explosive disorder (IED) involves impulsive or anger-based aggressive outbursts that begin rapidly and have very little build up. The aggressive episodes are generally impulsive and or based in anger rather than premeditated. Aggressiveness must be “grossly out of proportion” to the provocation and accompanying psychosocial stressors.

Aims

There is a lack of evidence regarding management of IED. I present a case which was effectively managed with combination of antipsychotic and mood stabilizer.

Presented is a 26-year-old male educated upto B.A. presented with the severe spectrum of the illness with a duration of 2 years characterized by sudden outbursts of extreme violence involving destruction of property and physical injury against individuals. These acts would occur 4-6 times in a month lasting for approximately five minutes and was followed by remorse. The episodes were recurrent, unpredictable, and not directed to anything in particular.

Depression, anxiety, substance use disorders, antisocial personality disorder, borderline personality disorder and intellectual disability were ruled out. Systemic examination, including neurological examination was normal. Serum ceruloplasmin levels, serum copper, ultrasound whole abdomen and EEG were normal. Patient was managed on T. Divalproex sodium 1 gm and Cap. Fluoxetine 60mg. Behavioral therapy was initiated but patient did not follow up regularly.

Results

Patient had complete remission with no episode of aggression after 9 weeks of treatment. Improvement was maintained for 2 months till last follow up.

Conclusions

Combination of SSRI (Fluoxetine) and mood stabilizer (Sodium valproate) are effective options for management of IED, especially in cases when psychological interventions have failed or are not available. Further studies have been found to consider this as an effective treatment method, however research is still being warranted to confirm the continuous effectiveness of this treatment option.

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