title: Augmentation of clozapine with amisulpride: an effective therapeutic strategy for violent treatment-resistant schizophrenia patients in a UK high-security hospital.
abstract: OBJECTIVE
  Clozapine is used in the management of treatment-resistant schizophrenia and is effective in reducing aggression; however a subgroup of patients is poorly responsive. For violent patients in this group, there is limited literature on the use of strategies to augment clozapine with other agents. Here we present a case series of 6 schizophrenia patients, within a high-security hospital, who have a history of serious violence and who were treated with clozapine augmented with amisulpride.
  
  
  METHODS
  We reviewed case notes and health records for evidence of violence/aggression and positive factors such as engagement in activities, and Clinical Global Impression (CGI) scores were formulated. We also examined metabolic parameters before and after augmentation.
  
  
  RESULTS
  All 6 of the patients showed clinical improvement in symptoms and a reduction in their risk of violence to others. Five patients had a reduction in number of violent/aggressive incidents, and all patients showed improvement in engagement in occupational, vocational, and/or psychological work. Metabolic parameters were largely unchanged except for 1 patient whose Body Mass Index (BMI) increased. Five patients reported side effects as unchanged or improved.
  
  
  CONCLUSIONS
  These schizophrenia patients with a history of violence showed clinical improvement and reduced aggression and violence with amisulpride augmentation of clozapine. To our knowledge, this is the first report of an antiaggressive benefit of this combination in forensic psychiatric patients. Further studies are warranted to establish the efficacy and anti-aggressive effects of amisulpride augmentation of clozapine.
authors.affiliation: 1Medical Sciences Division, John Radcliffe Hospital, University of Oxford,Oxford,UK.
authors.forename: James E
authors.initials: JE
authors.lastname: Hotham
authors.affiliation: 1Medical Sciences Division, John Radcliffe Hospital, University of Oxford,Oxford,UK.
authors.forename: Patrick J D
authors.initials: PJ
authors.lastname: Simpson
authors.affiliation: 1Medical Sciences Division, John Radcliffe Hospital, University of Oxford,Oxford,UK.
authors.forename: Rosalie S
authors.initials: RS
authors.lastname: Brooman-White
authors.affiliation: 2Broadmoor High Secure Hospital,West London Mental Health NHS Trust,London,UK.
authors.forename: Amlan
authors.initials: A
authors.lastname: Basu
authors.affiliation: 2Broadmoor High Secure Hospital,West London Mental Health NHS Trust,London,UK.
authors.forename: Callum C
authors.initials: CC
authors.lastname: Ross
authors.affiliation: 2Broadmoor High Secure Hospital,West London Mental Health NHS Trust,London,UK.
authors.forename: Sharon A
authors.initials: SA
authors.lastname: Humphreys
authors.affiliation: 2Broadmoor High Secure Hospital,West London Mental Health NHS Trust,London,UK.
authors.forename: Fintan
authors.initials: F
authors.lastname: Larkin
authors.affiliation: 4Department of Psychiatry, Government Medical College & Hospital,Chandigarh,India.
authors.forename: Nitin
authors.initials: N
authors.lastname: Gupta
authors.affiliation: 2Broadmoor High Secure Hospital,West London Mental Health NHS Trust,London,UK.
authors.forename: Mrigendra
authors.initials: M
authors.lastname: Das
mesh_terms: D000328:Adult; D000374:Aggression / Q000523:psychology; D000077582:Amisulpride; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D002784:Cholesterol / Q000378:metabolism; D008076:Cholesterol, HDL / Q000378:metabolism; D003024:Clozapine / Q000627:therapeutic use*; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D006778:Hospitals, Psychiatric; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012559:Schizophrenia / Q000188:drug therapy*; D012565:Schizophrenic Psychology; D012637:Security Measures; D013469:Sulpiride / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome; D006113:United Kingdom; D014754:Violence / Q000517:prevention & control* / Q000523:psychology; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents; D001786:Blood Glucose; D008076:Cholesterol, HDL; D013469:Sulpiride; D000077582:Amisulpride; D002784:Cholesterol; D003024:Clozapine