Atypical antipsychotic agents in the treatment of violent patients with schizophrenia and schizoaffective disorder

Menahem I. Krakowski, P. Czobor, Leslie Citrome, Nigel Bark, Thomas B. Cooper

Research output: Contribution to journalArticle

218 Citations (Scopus)

Abstract

Context: Violent behavior of patients with schizophrenia prolongs hospital stay and interferes with their integration into the community. Finding appropriate treatment of violent behaviors is of primary importance. Objective: To compare the efficacy of 2 atypical antipsychotic agents, clozapine and olanzapine, with one another and with haloperidol in the treatment of physical assaults and other aggressive behaviors in physically assaultive patients with schizophrenia and schizoaffective disorder. Design and Setting: Randomized, double-blind, parallel-group, 12-week trial. Physically assaultive subjects with schizophrenia or schizoaffective disorder who were inpatients in state psychiatric facilities were randomly assigned to treatment with clozapine (n=37), olanzapine (n=37), or haloperidol (n=36). Main Outcome Measures: Number and severity of physical assaults as measured by the Modified Overt Aggression Scale (MOAS) physical aggression score and the number and severity of all aggressive events as measured by the MOAS overall score. Psychiatric symptoms were assessed through the Positive and Negative Syndrome Scale (PANSS). Results: Clozapine was superior to both olanzapine and haloperidol in reducing the number and severity of physical assaults as assessed by the MOAS physical aggression score and in reducing overall aggression as measured by the MOAS total score. Olanzapine was superior to haloperidol in reducing the number and severity of aggressive incidents on these 2 MOAS measures. There were no significant differences among the 3 medication groups in improvement of psychiatric symptoms as measured by the PANSS total score and the 3 PANSS subscales. Conclusions: Clozapine shows greater efficacy than olanzapine and olanzapine greater efficacy than haloperidol in reducing aggressive behavior. This antiaggressive effect appears to be separate from the antipsychotic and sedative action of these medications.

Original languageEnglish
Pages (from-to)622-629
Number of pages8
JournalArchives of General Psychiatry
Volume63
Issue number6
DOIs
Publication statusPublished - 2006

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olanzapine
Aggression
Psychotic Disorders
Antipsychotic Agents
Schizophrenia
Haloperidol
Clozapine
Psychiatry
Therapeutics
Hypnotics and Sedatives
Inpatients
Length of Stay
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Psychiatry and Mental health

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Atypical antipsychotic agents in the treatment of violent patients with schizophrenia and schizoaffective disorder. / Krakowski, Menahem I.; Czobor, P.; Citrome, Leslie; Bark, Nigel; Cooper, Thomas B.

In: Archives of General Psychiatry, Vol. 63, No. 6, 2006, p. 622-629.

Research output: Contribution to journalArticle

Krakowski, Menahem I. ; Czobor, P. ; Citrome, Leslie ; Bark, Nigel ; Cooper, Thomas B. / Atypical antipsychotic agents in the treatment of violent patients with schizophrenia and schizoaffective disorder. In: Archives of General Psychiatry. 2006 ; Vol. 63, No. 6. pp. 622-629.
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