The effects of clozapine on aggression and substance abuse in schizophrenic patients

Aggressive behavior in schizophrenic patients, although infrequent, is a se rious problem. It is, however, a relatively common reason for psychiatric a dmission and poses an increasing threat as more patients are cared for in t he community. There is a strong association between substance abuse and vio lent behavior, and comorbid substance abuse in schizophrenia is also a majo r problem. The recent introduction of the atypical antipsychotics has broug ht hope for the pharmacologic management of this group of patients. These n ewer agents are thought to have antiaggressive effects and perhaps decrease cravings for illicit substances and alcohol. Data from a number of studies have demonstrated that clozapine has antiaggressive effects. A retrospecti ve analysis of 331 schizophrenic patients assessed the effects of clozapine on hostility and aggression. At baseline, 31.4% of patients showed overt p hysical aggression, and after an average of 47 weeks of treatment with cloz apine, this rate had fallen to 1.1%. The antiaggressive effects of clozapin e were relatively specific and could not be explained by sedation or genera l antipsychotic effects. These effects were more pronounced than the effect s on other symptoms and were also present in those patients who showed the highest pretreatment levels of hostility and aggression. Clozapine may also be of benefit in the treatment of schizophrenic patients with comorbid sub stance abuse. After 6 months of treatment with clozapine, substance abusers and nonabusers with schizophrenia or schizoaffective disorder showed simil ar improvements on measures of psychopathology and psychosocial functioning .