J. Volavka et L. Citrome, Atypical antipsychotics in the treatment of the persistently aggressive psychotic patient: methodological concerns, SCHIZOPHR R, 35, 1999, pp. S23-S33
Aggressive behavior of psychotic patients impacts all aspects of their clin
ical care. Better treatments to address this problem are needed, and atypic
al antipsychotics, such as clozapine, risperidone, and perhaps quetiapine,
have shown promise. However, studying the psychopharmacology of aggression
is difficult because of the many methodological problems that arise in the
design of appropriate clinical trials. These include imprecise definitions
of aggression, the difficulty of measuring outcome because of the relative
rarity of aggressive events, bias in the selection of patients for study, i
nadequate and inappropriate control groups, and inattention to comorbiditie
s and concomitant medications in analyzing results. Since the usual outcome
measure is the aggressive event rate, a large sample size and lengthy base
line and trial periods are required when this rate is low. Furthermore, for
midable practical and ethical obstacles interfere with the many sound techn
iques (e.g. randomization) used in typical designs of psychopharmacological
clinical trials. Current research methods should be modified and new ones
developed in order to progress in assessing the antiaggressive effects of t
reatments. (C) 1999 Elsevier Science B.V. All rights reserved.