This week includes a closer look at rage, a new approach to suicide prevention, and another AI horror story.
Clinicians Map How to Recognize and Treat Explosive Outbursts
A new clinical review from Massachusetts General Hospital offers a detailed roadmap for understanding, evaluating, and managing rage. It portrays it as extreme anger that can overwhelm cognitive control and descend into aggressive behavior across medical, psychiatric, and neurological settings.
Published in Primary Care Companion for CNS Disorders, the report frames rage not as a standalone diagnosis but as a symptom that cuts across conditions. It can manifest nearly anywhere, from posttraumatic stress disorder and bipolar disorder to traumatic brain injury, dementia, substance use, and developmental disorders.
Unlike everyday anger or irritability, rage reflects a transient loss of behavioral inhibition, as dysregulated frontolimbic brain circuits fail to balance emotional arousal with executive control.
Using a detailed case vignette of a combat veteran with PTSD, traumatic brain injury, and alcohol abuse, the authors document how layered neurobiological vulnerability, trauma, and impaired distress tolerance can fuel rage. They add that there’s no single algorithm for diagnosing rage. But that careful evaluation – focusing on neurological injury, psychiatric comorbidity, substance use, and triggers – remains critical.
Management strategies, the authors note, are necessarily multimodal. Psychotherapeutic approaches – such as cognitive-behavioral therapy, dialectical behavioral therapy, mindfulness-based interventions, and acceptance-based therapies – can help patients identify triggers, restructure maladaptive thoughts, and tolerate intense emotions without acting on them.
Pharmacologic options – such as selective serotonin reuptake inhibitors, mood stabilizers, beta-blockers, alpha-2 agonists, and antipsychotics – might be implemented off-label when behavioral strategies aren’t enough. Or if (and when) rage suggests an underlying psychiatric or neurological disorder.
The authors conclude that recognizing rage as a transdiagnostic signal – rather than writing it off as a character flaw – can help keep patients safe, reinforce treatment adherence, and boost long-term outcomes.
IN OTHER PSYCHIATRY AND NEUROLOGY NEWS
- The Journal of Clinical Psychiatry reports that suicide prevention must move beyond one-size-fits-all care and use precision medicine to match each individual with the treatment most likely to save their life.
- PCC also features a case study of a 41-year-old man who developed symptoms of psychosis related to frequent occupational use of AI.
- JCP also reports that daily suicidal thoughts (paired with severe sleep problems) can push health care workers’ short-term suicide risk to staggering levels.
- Another PCC case report tells the story of a 29-year-old man who suffered kratom withdrawal that required intensive care management and resulted in subsequent cardiac arrest.
- And listen to the latest episode of “The JCP Podcast,” where our host chats with physician assistant Michael Asbach, MD, about workforce solutions in psychiatry.
