Study designs of evaluations included in the review
Any designs were considered, although only case reports with a clear diagnostic description were included. The duration of the studies ranged from 2 to 34 weeks.
Specific interventions included in the review
Valproic acid. A very wide range of 250 to 4,000 mg/day valproate was used; the mean maximum dose of valproate was 1,393.5 mg/day. The mean reported plasma valproate level was 62.44 microg/mL (range: 13 - 111 microg/mL).
In 12 of the 17 studies, participants were taking concurrent medications such as benzodiazepines, neuroleptics, antidepressants and other mood stabilisers.
Participants included in the review
Patients with aggressive or violent behaviour were classified according to four categories:
1. Dementia.
2. Organic brain syndromes including brain injuries.
3. Mental retardation.
4. Other diagnoses associated with aggressive behaviours, such as schizophrenia and schizo-affective and bipolar disorders.
The participants ranged in age from 8 to 97 years, with a mean age of 53.81 years.
Reports of patients with aggression and bipolar diagnosis were excluded since the efficacy of valproate for that indication has been well documented. Studies in patients with aggression in the context of an acute organic delirium were also excluded, because of the multitude of medical factors and concomitant medications usually involved that would make it difficult to draw valid conclusions.
Outcomes assessed in the review
Response to treatment, measured as a reduction in aggressive and violent behaviours generally by global clinical impressions. Six studies used a rating scale to measure aggression, four of which used the Overt Aggression Scale (OAS). Side-effects were also reported.
How were decisions on the relevance of primary studies made?
The authors do not state how the papers were selected for the review, or how many of the reviewers performed the selection.