Clozapine effective option for violent schizophrenia patients with conduct disorder

Medically Reviewed By : Dr. Kamal Kant Kohli

Published On 2021-02-03 16:45 GMT | Update On 2021-02-04 07:52 GMT

It has been recently observed by the researchers from the Department of Psychiatry, Nathan Kline Institute for Psychiatric Research, Orangeburg, N.Y. that when conduct disorder is present, clozapine is the optimal treatment in violent schizophrenia patients.

The study is published in the American Journal of Psychiatry.

Treatment of violence in schizophrenia remains a challenging problem, especially in patients with conduct disorder. Previous clinical studies did not select patients on the basis of violence and did not focus on conduct disorder.

Therefore, Menahem Krakowski and colleagues conducted a head-to-head comparison of clozapine, olanzapine, and haloperidol in the treatment of violent schizophrenia patients with and without conduct disorder.

A total of 99 individuals all of whom were physically assaultive schizophrenia patients, were randomly assigned to receive clozapine, olanzapine, or haloperidol in a 12-week double-blind trial. They were characterized on the basis of the presence or absence of conduct disorder before age 15. Assaults were recorded; their frequency and severity were scored on the Modified Overt Aggression Scale. Psychiatric symptoms were evaluated through the Positive and Negative Syndrome Scale.

The following findings were noted-

a. Patients with a history of conduct disorder had more frequent and severe assaults than those without conduct disorder during the 12-week trial.

b. Clozapine was superior to haloperidol and olanzapine in reducing assaults; olanzapine was superior to haloperidol.

c. Clozapine's greater anti-aggressive efficacy over haloperidol was substantially more pronounced in patients with conduct disorder than in patients without conduct disorder.

d. In patients with conduct disorder, clozapine was four times more likely than haloperidol to result in lower violence; in patients without conduct disorder, it was three times more likely to do so.

e. Olanzapine's superiority over haloperidol was also more pronounced in patients with conduct disorder.

Therefore, the authors concluded that "this study is the first to examine the effect of clozapine in violent schizophrenia patients with conduct disorder and when conduct disorder is present, clozapine is the optimal treatment."

Article Source : American Journal of Psychiatry

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Dr. Nandita Mohan

Dr. Nandita Mohan is a practicing pediatric dentist with more than 5 years of clinical work experience. Along with this, she is equally interested in keeping herself up to date about the latest developments in the field of medicine and dentistry which is the driving force for her to be in association with Medical Dialogues. She also has her name attached with many publications; both national and international. She has pursued her BDS from Rajiv Gandhi University of Health Sciences, Bangalore and later went to enter her dream specialty (MDS) in the Department of Pedodontics and Preventive Dentistry from Pt. B.D. Sharma University of Health Sciences. Through all the years of experience, her core interest in learning something new has never stopped. She can be contacted at editorial@medicaldialogues.in. Contact no. 011-43720751

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Clozapine effective option for violent schizophrenia patients with conduct disorder

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