clozapine and Conduct-Disorder

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. This study is a head-to-head comparison of clozapine, olanzapine, and haloperidol in the treatment of violent schizophrenia patients with and without conduct disorder.. Physically assaultive schizophrenia patients (N=99) 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.. Patients with a history of conduct disorder had more frequent and severe assaults than those without conduct disorder during the 12-week trial. Clozapine was superior to haloperidol and olanzapine in reducing assaults; olanzapine was superior to haloperidol. Clozapine's greater antiaggressive efficacy over haloperidol was substantially more pronounced in patients with conduct disorder than in patients without conduct disorder. 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. Olanzapine's superiority over haloperidol was also more pronounced in patients with conduct disorder.. This study is the first to examine the effect of clozapine in violent schizophrenia patients with conduct disorder. When conduct disorder is present, clozapine is the optimal treatment.

Topics: Adult; Antipsychotic Agents; Clozapine; Conduct Disorder; Double-Blind Method; Female; Haloperidol; Humans; Male; Olanzapine; Psychiatric Status Rating Scales; Schizophrenia; Violence

Topics: Aggression; Clozapine; Conduct Disorder; Haloperidol; Humans; Olanzapine; Psychotic Disorders; Schizophrenia; Violence

An open, naturalistic observational study design was used, in which a sample of seven boys between 10 and 14 years of age was assessed over 26 weeks.. The subjects were all diagnosed with conduct disorder (CD) and exhibited high levels of aggression that were refractory to psychosocial approaches (parent counseling, school counseling, and psychotherapy) and to more than three pharmacological treatments. Levels of aggression, side effects, and hematological parameters were evaluated weekly. Clinical response was evaluated using the standardized instruments Clinical Global Impressions (CGI) and Child Behavior Check List (CBCL) 6-18 before starting medication and after 26 weeks.. We observed good tolerability of clozapine in doses from 100 to 600 mg/day with no significant side effects or hematological changes. The CGI and CBCL 6-18 scales indicated that clozapine led to a marked control of symptoms.

Topics: Adolescent; Adolescent Behavior; Aggression; Antipsychotic Agents; Blood Cell Count; Child; Child Behavior; Clozapine; Conduct Disorder; Humans; Male

Topics: Aggression; Antipsychotic Agents; Clozapine; Conduct Disorder; Drug Resistance; Executive Function; Humans; Randomized Controlled Trials as Topic; Schizophrenia; Schizophrenic Psychology; Violence

This study tested the hypothesis that among patients with schizophrenia the risk and correlates of aggressive behavior differ depending on the level of positive symptoms. Two hundred and fifty-one adults with schizophrenia who were living in the community were assessed by psychiatrists using validated instruments. Patients and collaterals reported aggressive behavior. In a final multivariate model, aggressive behavior was significantly and positively associated with childhood conduct disorder, current use of illicit drugs, positive, threat-control-override (TCO), and depression symptoms. While 16% of the patients with two or fewer positive symptoms engaged in aggressive behavior in the previous six months, this was true of 28.4% of those with three or more positive symptoms (X2 (n=251,1)=5.48, P=0.019). Among patients with high positive symptoms, even univariate analyses failed to detect any factors associated with aggressive behavior other than medication non-compliance, typical antipsychotic medication, and clozapine. By contrast, among patients with few positive symptoms, aggressive behavior was associated with TCO and depression symptoms, young age, male sex, the number of childhood conduct disorder symptoms, prior aggressive behavior, and current illicit drug use. In phases of illness characterized by different levels of positive symptoms, the risk of aggressive behavior and the associated factors differ.

Topics: Adult; Age Factors; Aggression; Antipsychotic Agents; Clozapine; Conduct Disorder; Depression; Female; Humans; Male; Medication Adherence; Middle Aged; Psychiatric Status Rating Scales; Risk Assessment; Risk Factors; Schizophrenia; Schizophrenic Psychology; Sex Factors; Substance-Related Disorders; United Kingdom; Violence