Aggressività e disturbi della personalità: Valutazione dell'efficacia e dell'esistenza di fattori predittivi nel trattamento con fluvoxamina e litio

Aim. Aggressiveness is a complex phenomenon possibly found in many psychiatric disorders, among which the personality. Several studies on aggressiveness indicate an inhibitor role played by the serotoninergic system. Fluvoxamine, a serotonin re-uptake inhibitor, was chosen as the test drug for this study and was compared to placebo and to lithium. The aim was to assess the existence of predictors of positive answer in controlling aggressive behaviour in subjects affected by personality disorders. Methods. Sixty-five patients known for their aggressiveness were screened and underwent a 4 w treatment period with placebo; 50 of them met the selection criteria for personality disorders and were randomly assigned to the fluvoxamine or the lithium group for a treatment period of 180 d. Monthly assessments were made by using the following scales: the SRRS, the GAS, the 9-item SDAS, the PFAV and the SAS. Results. In borderline patients the PFAV and the SAS area 1 scores at time 0 are correlated with the treatment with fluvoxamine and lithium, whereas in antisocial patients there was no significant correlation between any rating scale at time 0 and the answer at the treatment. Conclusions. The results underline that PFAV and SAS area 1 score at time 0, that are respectively sick awareness and social adaptation (particularly in working context) are linked with a positive answer to the treatment with fluvoxamine and lithium in only the borderline patients.