Barcelona snapshots

Dr. Norma Verdolini

Norma Verdolini psiquiatra Controversias Psiquiatría Barcelona
Ponencia Tratamiento farmacológico del comportamiento agresivo y violento
Fechas 9 Septiembre - 11 Septiembre, 2020
Mesa redonda 6 El Manejo de la Violencia y la Agresión


Norma Verdolini graduated in Medicine in 2011 and performed a clinical residency in Psychiatry at the University of Perugia (Italy). In 2014 she performed a research attachment at the South Essex Partnership University NHS Foundation Trust in collaboration with the University of Cambridge, UK. In the last year of the specialty (2016) she collaborated with the Bipolar and Depressive Disorders Unit of the Hospital Clínic in Barcelona (Spain) and got involved in a project that aims to understand the psychiatric correlates of self- or hetero-aggression in bipolar disorder and decided to further my PhD thesis on this topic. After completing her clinical residency, she worked as a psychiatrist and clinical investigator. In January 2018 she joined FIDMAG Hermanas Hospitalarias Research Foundation (Spain) with a “Río Hortega” contract by the “Instituto de Salud Carlos III” to study the neurobiological basis of bipolar disorder. In November 2018 she defended her PhD thesis entitled “SELF- AND HETERO-AGGRESSION: Clinical Implications in Bipolar Disorder and Mixed States” at the University of Barcelona. The PhD thesis included few of her previous articles, for example “Aggressiveness in depression: a neglected symptom possibly associated with bipolarity and mixed features” published in Acta Psychiatrica Scandinavica, and “The aggressor at the mirror: Psychiatric correlates of deliberate self-harm in male prison inmates” published in European Psychiatry, among others. In May 2019 she became a post-doctoral fellow of the “Biomedicine international training research programme for excellent clinician-scientists-BITRECS”, funded by the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 754550 and from “La Caixa” Foundation, at the “Institut d'Investigacions Biomèdiques August Pi i Sunyer-IDIBAPS”, Barcelona. She is currently working in the research line focused on early stages in bipolar disorders, trying to identify the prodromes and predictors of the development of bipolar disorders.


Even though most psychiatric patients are not violent, severe mental illness, particularly schizophrenia and bipolar disorder, are associated with an increased risk of aggressive and violent behaviours.

Aggressive behaviours and violence should be addressed as a medical syndrome. It can be divided into the psychotic, impulsive and psychopathic subtypes. The neurobiology of both impulsive and psychotic aggression relies on structural and functional abnormalities in the frontal and temporal cortices that can be responsible of an inadequate cortical regulation. Also, an excessive reactivity to perceived threats resulting in hyperactivity of the amygdala has been found. Effective treatment strategies are particularly aimed at reducing the psychopathologic substrate of aggressive and violent behaviours as well as at decreasing the imbalances in the neurotransmitters dopamine and serotonin.

Short-term treatment is generally aimed at calming the patient as rapidly as possible, without excessive sedation and decreasing the likelihood of harm to self or others. Long-term treatment is focused on the prevention of agitation and aggression.

The most effective treatment so far is clozapine, with a quite good randomized controlled trial evidence in support of its specific anti-aggressive effect. Other antipsychotics proved also to be effective. The current strategy is to achieve high degrees of dopamine D2 receptor occupancy, by utilizing higher doses or a combination of antipsychotics. Anticonvulsants or lithium are generally prescribed as augmentation treatments, particularly in the case of bipolar disorder. Worthy of note is the evidence of an association between non-adherence to treatment and violence. As a consequence, long-acting formulations might represent a possibility as well as psychoeducation and non-pharmacological treatment strategies are recommended. Comorbid substance misuse and personality disorders should also be addressed. Further large, randomized, controlled trials as well as consistency in the outcome measures, diagnostic tools and definitions of aggressive and violent behaviours are needed.