The use of clozapine in the treatment of aggressive schizophrenia.
The atypical antipsychotic drug clozapine was introduced to clinical practice in 1972. It is a dibenzodiazepine derivative with, among other known receptor site activities, a relatively high D1/D2 receptor affinity ratio. The serious side effects of bone marrow suppression and agranulocytosis delayed the acceptance of clozapine into common clinical practice but scrupulous application of a monitoring protocol led to adequate protection from these side effects. There is now a broad consensus about the benefits of clozapine which supports the use of clozapine as a first-line treatment of schizophrenia. There is good evidence that relapse and rehospitalization drop to 22% of the incidence in preclozapine treatment patients. The majority of responders are identified within 4 months of treatment. Clozapine has been demonstrated to be an effective treatment for neuroleptic refractory patients. Forty percent of clozapine-treated patients show significant improvement, with 11% of treated patients showing no residual psychosis. This review also describes the results of clozapine on aggressive and violent assault in a patient population characterized by severe functional deficits, typically chronic schizophrenia with severe impairment, chronic brain syndromes, and developmental handicap. Prior to the introduction of clozapine therapy, in a chronically disrupted milieu that precluded adequate psychosocial programming, seriously assaultive behaviour resulting in peer and staff injury was a common occurrence. Evidence suggests that clozapine is an effective medical treatment for the target symptoms of hostile agitation, threatening, and assaultive violence.
Hector
R I
RI
Oak Ridge Division, Mental Health Centre Penetanguishene, Ontario. ormedpsych@mchp.on.ca
D000284:Administration, Oral; D000374:Aggression / Q000187:drug effects* / Q000523:psychology; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D003024:Clozapine / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005555:Forensic Psychiatry; D006801:Humans; D016651:Lithium Carbonate / Q000627:therapeutic use; D009864:Ontario; D012149:Restraint, Physical; D012559:Schizophrenia / Q000188:drug therapy*; D012565:Schizophrenic Psychology; D012934:Social Isolation
D014150:Antipsychotic Agents; D016651:Lithium Carbonate; D003024:Clozapine