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VII. CRITERIA FOR EVALUATING EXPOSURE TO FLUORIDE. Diagnoses could have a differential response to propranolol. Because only a few patients entered the double-blind phase of the study, we were unable to statistically analyze continued response versus relapse. Propranolol was used in addition to concurrent medications, and therefore we cannot ascertain whether response was due to propranolol or to the combination of medications. We used high doses of propranolol in order to ensure that all patients received an adequate trial. Propranolol was well tolerated in these patients, without significant adverse effects. The preponderance of published reports suggests that a dosage of 640 mg per day is usually effective. Beta-blockers should not be administered to patients with specific physical illnesses, such as bronchospasm, diabetes, thyroid disease, and heart failure. We did not observe any depression in our group of patients, and we believe that the occurrence of depression with propranolol treatment has been overstated.29, 30 The results of this study are consistent with antiaggressive effects of propranolol in a cohort of violent, chronically hospitalized patients. Further studies of the effects of beta-blockers in the treatment of aggression are necessary. It is critical for future research efforts to include the objective documentation of aggressive behaviors so that specific criteria for response can be demonstrated and minoxidil.

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