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Book Review   |    
Impulsivity: Theory, Assessment, and Treatment
Douglas Hughes, M.D.
Psychiatric Services 1998; doi:
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edited by Christopher D. Webster, Ph.D., and Margaret A. Jackson, Ph.D; New York City, Guilford Press, 1997, 462 pages, $46.95

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Impulsive aggression and violence are ranked as major concerns in North America despite statistics that some forms of violence are in decline. Research and academic dialogues on violence and its antecedents are essential if we are to ever understand and control this behavior. Impulsivity is characteristic of many psychiatric disorders and is vitally linked to the risk assessments of homicidal and suicidal patients.

The chapters in this text were written in response to a conference on impulsivity sponsored by the psychology department and the School of Criminology at Simon Fraser University in Burnaby, British Columbia, in 1994. The 30 authors are academics, researchers, and clinicians. All but one are from Canada, and half are faculty at Simon Fraser University. The authors approach impulsivity from many different angles. The diversity of viewpoints provides for a richness of thought.

The book's 23 chapters are divided into four major sections. The first section is devoted to theoretical issues related to impulsivity, presenting clinical, social, legal, and cybernautical perspectives. Maxwell Clark's chapter, "A Cybernautical Perspective on Impulsivity and Addiction," is an enjoyable and speculative contribution about cyberspace and its potential influence on nonconformity and impulsive behavior.

The second section, Foundations, initially explores the biopsychology of impulsivity. Donald Coscina's opening chapter, focusing on brain serotonin, gives a clear and concise overview of the theorized underpinnings of aggression. The section also examines impulsivity in children, adolescents, and adults and includes a review of impulsivity occurring in major mental and personality disorders.

The third section focuses on assessment of impulsivity. The authors examine assessment of the risk of violence to self and others, particularly areas like sexual violence and domestic violence.

The final section details treatment options, including treatment programs, integrated support, systems approaches, and pharmacological treatments. Neil Conacher's chapter on "Pharmacological Approaches to Impulsive and Aggressive Behavior," while only ten pages long, clearly reviews pharmacological agents currently used for treating the impulsive patient. The studies of the atypical neuroleptics showing beneficial effects on hostility and aggression are encouraging. Both clozapine and risperidone have a possible selective effect on hostility compared with both placebo and haloperidol, a typical neuroleptic.

Perhaps in future editions the editors will broaden the scope of the chapter on legal perspectives to encompass case law in the United States as well as in Canada. Many clinicians deal with the dilemma of protecting patient confidentiality while warning the public about their impulsively violent patients. This text covers wife assault and sexual violence, which are critical issues. Including sections on how to protect children, the developmentally disabled, and the elderly would also be valuable.

The editors and authors have compiled a fine book on impulsivity and aggression. This text will be a valuable reference for both the clinicians who treat impulsive patients and the academics who research aggression.

Dr. Hughes is affiliated with the Veterans Affairs Medical Center in Boston and Boston University School of Medicine.




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