CLOZAPINE REDUCES VIOLENCE AND PERSISTENT AGGRESSION IN SCHIZOPHRENIA

Violence and persistent aggression are serious problems in the general population and among certain psychiatric patients. Violence and persi stent aggression have been associated with suicidal ideation and subst ance abuse, characteristics of chronically ill, and in many instances, treatment-resistant schizophrenia individuals. Assessment of dangerou sness in psychiatric patients involves evaluation of sociodemographic and clinical factors. A substantial number of neurologic and psychiatr ic disorders are associated with pathologic anger and aggression; of t hese, the association between schizophrenia and violence/aggression is the best described. Neurotransmitters that have been implicated in ag gressive and violent behavior include serotonin, norepinephrine, and d opamine. Current pharmacotherapy of pathologic aggression involves the use of multiple agents on a trial-and-error basis, with varying degre es of response. Unfortunately, this approach subjects patients to nume rous side effects, including the extrapyramidal symptoms associated wi th the use of conventional antipsychotics. This paper will review evid ence for the efficacy of clozapine in the treatment of aggression and violence in the treatment-refractory patient. The reduction in violenc e and persistent aggression with clozapine treatment should improve th e chances for integration of the schizophrenia patient into the commun ity and provide cost savings to society.