title: Overt aggression and psychotic symptoms in patients with schizophrenia treated with clozapine, olanzapine, risperidone, or haloperidol.
abstract: The subjects were 157 treatment-resistant inpatients diagnosed with chronic schizophrenia or schizoaffective disorder. They were randomly assigned to treatment with clozapine, olanzapine, risperidone, or haloperidol in a 14-week, double-blind trial. Incidents of overt aggression were recorded and their severity was scored. The Positive and Negative Syndrome Scale was administered. Atypical antipsychotics showed an overall superiority over haloperidol, particularly after the first 24 days of the study when the dose escalation of clozapine was completed. Once an adequate therapeutic dose of clozapine was reached, it was superior to haloperidol in reducing the number and severity of aggressive incidents. Patients exhibiting persistent aggressive behavior showed less improvement of psychotic symptoms than the other patients. There was an interaction between aggressiveness, medication type, and antipsychotic response: risperidone and olanzapine showed better antipsychotic efficacy in patients exhibiting less aggressive behavior; the opposite was true for clozapine. Clozapine appears to have superior antiaggresive effects in treatment-resistant patients; this superiority develops after the patient has been exposed to an adequate dose regimen.
authors.affiliation: Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY 10982, USA. Volavka@NKI.RFMH.ORG
authors.forename: Jan
authors.initials: J
authors.lastname: Volavka
authors.forename: Pal
authors.initials: P
authors.lastname: Czobor
authors.forename: Karen
authors.initials: K
authors.lastname: Nolan
authors.forename: Brian
authors.initials: B
authors.lastname: Sheitman
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Lindenmayer
authors.forename: Leslie
authors.initials: L
authors.lastname: Citrome
authors.forename: Joseph P
authors.initials: JP
authors.lastname: McEvoy
authors.forename: Thomas B
authors.initials: TB
authors.lastname: Cooper
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Lieberman
mesh_terms: D000374:Aggression / Q000523:psychology*; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000627:therapeutic use; D003024:Clozapine / Q000627:therapeutic use; D004311:Double-Blind Method; D006220:Haloperidol / Q000627:therapeutic use; D006801:Humans; D000077152:Olanzapine; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D011618:Psychotic Disorders / Q000523:psychology*; D018967:Risperidone / Q000627:therapeutic use; D012559:Schizophrenia / Q000150:complications* / Q000188:drug therapy*; D012565:Schizophrenic Psychology
chemical_list: D014150:Antipsychotic Agents; D001569:Benzodiazepines; D003024:Clozapine; D006220:Haloperidol; D018967:Risperidone; D000077152:Olanzapine