This is a revised Mentored Clinical Scientist Development Award application that describes a program of training and research on the correlates and treatment of parent-to-child aggression in parents who have physically abused their child. The candidate's goal is to acquire the training needed to conduct controlled trials of integrated psychotherapeutic and psychopharmacologic interventions designed to reduce parent-to-child aggression. This goal is to be achieved through the proposed research and through the educational plan consisting of independent study, courses in statistics and research design, and clinical work with abusive families. Because child physical abuse (CPA) involves parent-to-child aggression, the wealth of literature on aggression in other settings can be used to better understand CPA. The proposed study is informed by the following findings: anger contributes to aggressive behavior, persons with high compared to low levels of anger show more aggressive behavior, and serotonergic antidepressants such as fluoxetine reduce anger and aggression. This randomized double-blind placebo controlled study will examine whether fluoxetine adds to standard treatment for physically abusive parents in the community, by examining the effectiveness of fluoxetine in reducing aggression among abusive parents assigned to Fluoxetine plus Treatment-as-Usual (TAU) or Placebo plus TAU. A causal model of parental aggression will also be examined. Specifically, the role of anger will be examined as a mediator of the effects of the following variables implicated in CPA: psychopathology (depression and anxiety), social cognition, physiologic arousability, impulsivity and selected ecological factors. Eighty abusive parents will be studied. In contrast to cognitive-behavior therapy, fluoxetine may reduce aggression through reducing the intensity of angry emotion and its attendant arousal and aggressive action tendencies. Thus, if fluoxetine reduces parental aggression, it may prove to be a useful adjunct to psychotherapeutic interventions currently used to treat CPA. Prior studies of abusive parents have not examined these variables within a single sample and there are no trials of antidepressants in this group. This application, which combines training and experience in causal and treatment research, may contribute to the understanding and treatment of child physical abuse.
| Mammen, Oommen K; Pilkonis, Paul A; Chengappa, Kadiamada N R et al. (2004) Anger attacks in bipolar depression: predictors and response to citalopram added to mood stabilizers. J Clin Psychiatry 65:627-33 |
| Mammen, Oommen K; Kolko, David J; Pilkonis, Paul A (2002) Negative affect and parental aggression in child physical abuse. Child Abuse Negl 26:407-24 |
