Violent or threatening behavior is a frequent reason for the admission to a psychiatric inpatient facility, and that behavior may continue after the admission. The distinction between transient and recidivistic assaultiveness is clinically important: a small group of recidivistic patients may cause the majority of violent incidents. Patients with persistent aggressive behavior must first be assessed for the possibility of comorbid conditions. Short- term sedation with lorazepam is a safe and effective choice for acute agitation, although the new intramuscular preparations of the atypical antipsychotics may prove to be a better alternative for the acutely agitated psychotic patient. Longer-term solutions include strategies that would decrease impulsivity. Mood stabilizers, especially valproate, are commonly used with neuroleptics to decrease the intensity and frequency of agitation and poor impulse control, but they have not been extensively studied under double-blind, placebo-controlled conditions. Clozapine appears to be more effective than typical neuroleptics, as well as risperidone, in specifically reducing aggressivity in patients with schizophrenia or schizoaffective disorder. Beta blockers, well studied in the treatment of aggressive behavior in brain injured patients, may also be helpful as an adjunctive agent to antipsychotics for aggression and schizophrenia. Adjunctive serotonin- specific reuptake inhibitors are another option for this population. The simultaneous use of multiple psychotropic agents will be discussed.