Overt Aggression and Psychotic Symptoms in Patients with Schizophrenia Treated with Clozapine, Olanzapine, Risperidone, or Haloperidol

Journal Article

The subjects were 157 treatment-resistant inpatients diagnosed with chronic schizophrenia or schizoaffective disorder. They were randomly assigned to treatment with clozapine, olanzapine, risperidone, or haloperidol in a 14-week, double-blind trial. Incidents of overt aggression were recorded and their severity was scored. The Positive and Negative Syndrome Scale was administered. Atypical antipsychotics showed an overall superiority over haloperidol, particularly after the first 24 days of the study when the dose escalation of clozapine was completed. Once an adequate therapeutic dose of clozapine was reached, it was superior to haloperidol in reducing the number and severity of aggressive incidents. Patients exhibiting persistent aggressive behavior showed less improvement of psychotic symptoms than the other patients. There was an interaction between aggressiveness, medication type, and antipsychotic response: risperidone and olanzapine showed better antipsychotic efficacy in patients exhibiting less aggressive behavior; the opposite was true for clozapine. Clozapine appears to have superior antiaggresive effects in treatment-resistant patients; this superiority develops after the patient has been exposed to an adequate dose regimen.

Full Text

Duke Authors

Cited Authors

  • Volavka, J; Czobor, P; Nolan, K; Sheitman, B; Lindenmayer, JP; Citrome, L; McEvoy, JP; Cooper, TB; Lieberman, JA

Published Date

  • 2004

Published In

Volume / Issue

  • 24 / 2

Start / End Page

  • 225 - 228

International Standard Serial Number (ISSN)

  • 0271-0749

Digital Object Identifier (DOI)

  • 10.1097/01.jcp.0000117424.05703.29