Clozapine Reduces Violence and Persistent Aggression in Schizophrenia

Violence and persistent aggression are serious problems in the general population and among certainpsychiatric patients. Violence and persistent aggression have been associated with suicidal ideation andsubstance abuse, characteristics of chronically ill, and in many instances, treatment-resistant schizophreniaindividuals. Assessment of dangerousness in psychiatric patients involves evaluation of sociodemographicand clinical factors. A substantial number of neurologic and psychiatric disorders are associated withpathologic anger and aggression; of these, the association between schizophrenia and violence/aggressionis the best described. Neurotransmitters that have been implicated in aggressive and violent behavior includeserotonin, norepinephrine, and dopamine. Current pharmacotherapy of pathologic aggression involvesthe use of multiple agents on a trial-and-error basis, with varying degrees of response. Unfortunately,this approach subjects patients to numerous side effects, including the extrapyramidal symptomsassociated with the use of conventional antipsychotics. This paper will review evidence for the efficacy ofclozapine in the treatment of aggression and violence in the treatment-refractory patient. The reduction inviolence and persistent aggression with clozapine treatment should improve the chances for integration ofthe schizophrenia patient into the community and provide cost savings to society.