Skip to main content Accessibility help
×
Home

Pharmacological treatment of violence in schizophrenia

Published online by Cambridge University Press:  25 July 2019


Martin T. Strassnig
Affiliation:
Department of Psychiatry, University of Miami, Miami, FL, USA
Vanessa Nascimento
Affiliation:
University of Miami, Miller School of Medicine, Miami, FL, USA
Elizabeth Deckler
Affiliation:
University of Miami, Miller School of Medicine, Miami, FL, USA
Philip D. Harvey
Affiliation:
Department of Psychiatry, University of Miami, Miami, FL, USA Bruce W. Carter VA Medical Center, Miami, FL, USA.
Corresponding
E-mail address:

Abstract

Chronic aggression and violence in schizophrenia are rare, but receive disproportionate negative media coverage. This contributes to the stigma of mental illness and reduces accessibility to mental health services. Substance Use Disorders (SUD), antisocial behavior, non-adherence and recidivism are known risk factors for violence. Treatment with antipsychotic medication can reduce violence. Aside from clozapine, long-acting injectable antipsychotics (LAI) appear to be superior to oral antipsychotics for preventing violence, addressing adherence and recidivism. LAI also facilitate the implementation of functional skills training. For the high-risk recidivist target population with schizophrenia, better life skills have the potential to also reduce the risk for contact with the legal system, including an improved ability to live independently in supported environments and interact appropriately with others. High-risk patients who are resistant to treatment with other antipsychotics should receive treatment with clozapine due to its direct positive effects on impulsive violence, along with a reduction in comorbid risk factors such as SUDs.


Type
Review
Copyright
© Cambridge University Press 2019

Access options

Get access to the full version of this content by using one of the access options below.

References

Citrome, L, Volavka, J. The psychopharmacology of violence: making sensible decisions. CNS Spectr. 2014; 19(5): 411418.CrossRefGoogle ScholarPubMed
Meyer, JM, Cummings, MA, Proctor, G, et al.Psychopharmacology of persistent violence and aggression. Psychiatr Clin North Am. 2016; 39(4): 541556.CrossRefGoogle ScholarPubMed
Fazel, S, Gulati, G, Linsell, L, et al.Schizophrenia and violence: systematic review and meta-analysis. PLoS Med. 2009; 6(8): e1000120.CrossRefGoogle ScholarPubMed
Witt, K, van Dorn, R, Fazel, S. Risk factors for violence in psychosis: systematic review and meta-regression analysis of 110 studies. PLoS One. 2013; 8(2): e55942.CrossRefGoogle ScholarPubMed
Sariaslan, A, Lichtenstein, P, Larsson, H, et al.Triggers for violent criminality in patients with psychotic disorders. JAMA Psychiatry. 2016; 73(8): 796803.CrossRefGoogle ScholarPubMed
Torrey, EF. Stigma and violence: isn’t it time to connect the dots? Schizophr Bull. 2011; 37(5): 892896.CrossRefGoogle ScholarPubMed
Bhavsar, V, Bhugra, D. Violence towards people with mental illness: assessment, risk factors, and management. Psychiatry Clin Neurosci. 2018; 72(11): 811820.CrossRefGoogle ScholarPubMed
Walsh, E, Buchanan, A, Fahy, T. Violence and schizophrenia: examining the evidence. Br J Psychiatry. 2002; 180: 490495.CrossRefGoogle ScholarPubMed
Nolan, KA, Volavka, J, Czobor, P, et al. Aggression and psychopathology in treatment-resistant in patients with schizophrenia and schizoaffective disorder. J Psychiatr Res. 2005; 39(1): 109115.CrossRefGoogle ScholarPubMed
Quanbeck, CD, McDermott, BE, Lam, J, et al.Categorization of aggressive acts committed by chronically assaultive state hospital patients. Psychiatr Serv. 2007; 58(4): 521528.CrossRefGoogle ScholarPubMed
Sirotich, F. The criminal justice outcomes of jail diversion programs for persons with mental illness: a review of the evidence. J Am Acad Psychiatry Law 2009; 37(4): 461472.Google Scholar
Volavka, J, Van Dorn, RA, Citrome, L, et al.Hostility in schizophrenia: an integrated analysis of the combined Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) and the European First Episode Schizophrenia Trial (EUFEST) studies. Eur Psychiatry. 2016; 31: 1319.CrossRefGoogle ScholarPubMed
Morrissette, DA, Stahl, SM. Treating the violent patient with psychosis or impulsivity utilizing antipsychotic polypharmacy and high-dose monotherapy. CNS Spectr. 2014; 19: 439448.CrossRefGoogle ScholarPubMed
Patchan, K, Vyas, G, Hackman, AL, et al.Clozapine in reducing aggression and violence in forensic populations. Psychiatr Q. 2018; 89(1): 157168.CrossRefGoogle ScholarPubMed
Ratey, JJ, Leveroni, C, Kilmer, D, et al.The effects of clozapine on severely aggressive psychiatric inpatients in a state hospital. J Clin Psychiatry. 1993; 54(6): 219223.Google ScholarPubMed
Rabinowitz, J, Avnon, M, Rosenberg, V. Effect of clozapine on physical and verbal aggression. Schizophr Res. 1996; 22(3): 249255.CrossRefGoogle ScholarPubMed
Chiles, JA, Davidson, P, McBride, D. Effects of clozapine on use of seclusion and restraint at a state hospital. Hosp Community Psychiatry. 1994; 45(3): 269271.Google ScholarPubMed
Sinyor, M, Remington, G. Is psychiatry ignoring suicide? The case for clozapine. J Clin Psychopharmacol. 2012; 32(3): 307308.CrossRefGoogle ScholarPubMed
Brunette, MF, Drake, RE, Xie, H, et al.Clozapine use and relapses of substance use disorder among patients with co-occurring schizophrenia and substance use disorders. Schizophr Bull. 2006; 32(4): 637643.CrossRefGoogle ScholarPubMed
Misawa, F, Kishimoto, T, Hagi, K, et al.Safety and tolerability of long-acting injectable versus oral antipsychotics: a meta-analysis of randomized controlled studies comparing the same antipsychotics. Schizophr Res. 2016; 176(2–3): 220220.CrossRefGoogle ScholarPubMed
Khan, AY, Salaria, S, Ovais, M, et al.Depot antipsychotics: where do we stand? Ann Clin Psychiatry. 2016; 28(4): 289298.Google ScholarPubMed
Arango, C, Bombin, I, Gonzalez-Salvador, T, et al.Randomised clinical trial comparing oral versus depot formulations of zuclopenthixol in patients with schizophrenia and previous violence. Eur Psychiatry. 2006; 21(1): 3440.CrossRefGoogle ScholarPubMed
Correll, CU, Citrome, L, Haddad, PM, et al.The use of long-acting injectable antipsychotics in schizophrenia: evaluating the evidence. J Clin Psychiatry. 2016; 77(Suppl.3): 124.CrossRefGoogle ScholarPubMed
Rezansoff, SN, Moniruzzaman, A, Fazel, S, et al.Adherence to antipsychotic medication and criminal recidivism in a Canadian provincial offender population. Schizophr Bull. 2017; 43(5): 10021010.CrossRefGoogle Scholar
Lynn Starr, H, Bermak, J, Mao, L, et al.Comparison of long-acting and oral antipsychotic treatment effects in patients with schizophrenia, comorbid substance abuse, and a history of recent incarceration: an exploratory analysis of the PRIDE study. Schizophr Res. 2018; 194: 3946.CrossRefGoogle Scholar
Iozzino, L, Ferrari, C, Large, M, et al.Prevalence and risk factors of violence by psychiatric acute inpatients: a systematic review and meta-analysis. PLoS One. 2015; 10(6): e0128536.CrossRefGoogle ScholarPubMed
Trudeau, KJ, Burtner, J, Villapiano, AJ, et al.Burden of schizophrenia or psychosis-related symptoms in adults undergoing substance abuse evaluation. J Nerv Ment Dis. 2018; 206(7): 528536.CrossRefGoogle ScholarPubMed
Alphs, L, Benson, C, Cheshire-Kinney, K, et al.Real-world outcomes of paliperidone palmitate compared to daily oral antipsychotic therapy in schizophrenia: a randomized, open-label, review board-blinded 15-month study. J Clin Psychiatry. 2015; 76(5): 554561.CrossRefGoogle ScholarPubMed
Strassnig, M, Bowie, C, Pinkham, AE, et al.Which levels of cognitive impairments and negative symptoms are related to functional deficits in schizophrenia? J Psychiatr Res. 2018; 104: 124129.CrossRefGoogle Scholar
Fu, DJ, Turkoz, I, Walling, D, et al.Paliperidone palmitate once-monthly maintains improvement in functioning domains of the personal and social performance scale compared with placebo in subjects with schizoaffective disorder. Schizophr Res. 2018; 192: 185193.CrossRefGoogle ScholarPubMed
Montemagni, C, Frieri, T, Rocca, P. Second-generation long-acting injectable antipsychotics in schizophrenia: patient functioning and quality of life. Neuropsychiatr Dis Treat. 2016; 12: 917929.Google ScholarPubMed
Sajatovic, M, Ramirez, LF, Fuentes-Casiano, E, et al.A 6-month prospective trial of a personalized behavioral intervention + long-acting injectable antipsychotic in individuals with schizophrenia at risk of treatment nonadherence and homelessness. J Clin Psychopharmacol. 2017; 37(6): 702707.CrossRefGoogle ScholarPubMed
Medrano, S, Abdel-Baki, A, Stip, E, et al.Three-year naturalistic study on early use of long-acting injectable antipsychotics in first episode psychosis. Psychopharmacol Bull. 2018; 48(4): 2561.Google Scholar
Krakowski, MI, Czobor, P. Depression and impulsivity as pathways to violence: implications for antiaggressive treatment. Schizophr Bull. 2014; 40(4): 886894.CrossRefGoogle ScholarPubMed
Krakowski, MI, Czobor, P, Citrome, L, et al.Atypical antipsychotic agents in the treatment of violent patients with schizophrenia and schizoaffective disorder. Arch Gen Psychiatry. 2006; 63(6): 622-629.CrossRefGoogle ScholarPubMed
Krakowski, M, Czobor, P, Citrome, L. Weight gain, metabolic parameters, and the impact of race in aggressive inpatients randomized to double-blind clozapine, olanzapine or haloperidol. Schizophr Rese. 2009; 110(1–3): 95102.CrossRefGoogle ScholarPubMed
Citrome, L, Volavka, J, Czobor, P, et al.Effects of clozapine, olanzapine, risperidone, and haloperidol on hostility among patients with schizophrenia. Psychiatr Serv. 2001; 52(11): 15101514.CrossRefGoogle ScholarPubMed
Swanson, JW, Swartz, MS, Van Dorn, RA, et al.Comparison of antipsychotic medication effects on reducing violence in people with schizophrenia. Br J Psychiatry. 2008; 193(1): 3743.CrossRefGoogle ScholarPubMed
Hodgins, S, Riaz, M. Violence and phases of illness: differential risk and predictors. Eur Psychiatry. 2011; 26(8): 518524.CrossRefGoogle ScholarPubMed
Swanson, JW, Swartz, MS, Elbogen, EB. Effectiveness of atypical antipsychotic medications in reducing violent behavior among persons with schizophrenia in community-based treatment. Schizophr Bull. 2004; 30(1): 320.CrossRefGoogle ScholarPubMed
Chengappa, KN, Vasile, J, Levine, J, et al.Clozapine: its impact on aggressive behavior among patients in a state psychiatric hospital. Schizophr Res. 2002; 53(1–2): 16.CrossRefGoogle Scholar
Fond, G, Boyer, L, Boucekine, M, et al.Illness and drug modifiable factors associated with violent behavior in homeless people with severe mental illness: results from the French Housing First (FHF) program. Prog Neuro-Psychopharmacol & Biol Psychiatry. 2019; 90: 9296.CrossRefGoogle ScholarPubMed
Kranzler, H, Roofeh, D,Gerbino-Rosen, G, et al.Clozapine: its impact on aggressive behavior among children and adolescents with schizophrenia. J Am Acad Child Adolesc Psychiatry. 2005; 44(1): 5563.CrossRefGoogle ScholarPubMed
Chalasani, L, Kant, R, Chengappa, KN. Clozapine impact on clinical outcomes and aggression in severely ill adolescents with childhood-onset schizophrenia. Can J Psychiatr. 2001; 46(10): 965968.CrossRefGoogle ScholarPubMed
Cohen, SA, Underwood, MT. The use of clozapine in a mentally retarded and aggressive population. J Clin Psychiatr. 1994; 55(10): 440444.Google Scholar
Hotham, JE, Simpson, PJ, Brooman-White, RS, et al.Augmentation of clozapine with amisulpride: an effective therapeutic strategy for violenttreatment-resistant schizophrenia patients in a UK high-security hospital. CNS Spectr. 2014; 19(5): 403410.CrossRefGoogle Scholar
Ifteni, P, Szalontay, AS, Teodorescu, A. Reducing restraint with clozapine in involuntarily admitted patients with schizophrenia. Am J Ther. 2017; 24(22): 222226.CrossRefGoogle ScholarPubMed
Volavka, J. The effects of clozapine on aggression and substance abuse in schizophrenic patients. J ClinPsychiatry. 1999; 60: 4346.Google ScholarPubMed
Balbuena, L, Mela, M, Wong, S, et al.Does clozapine promote employability and reduce offending among mentally disordered offenders? Can J Psychiatry. 2010; 55(1): 5056.CrossRefGoogle ScholarPubMed
Kraus, JE, Sheitman, BB. Clozapine reduces violent behavior in heterogeneous diagnostic groups. J Neuropsychiatr Clin Neurosci. 2005; 17(1): 3644.CrossRefGoogle ScholarPubMed
Kelly, DL, Conley, RR, Feldman, S, et al.Adjunct divalproex or lithium to clozapine in treatment-resistant schizophrenia. Psychiatr Q. 2006; 77(1): 8195.CrossRefGoogle ScholarPubMed
Kisely, SR, Campbell, LA. Compulsory community and involuntary outpatient treatment for people with severe mental disorders. Schizophr Bull. 2015; 41(3): 542543.CrossRefGoogle ScholarPubMed
Swartz, MS, Bhattacharya, S, Robertson, AG, et al.Involuntary outpatient commitment and the elusive pursuit of violence prevention. Can J Psychiatr. 2017; 62(2): 102108.CrossRefGoogle ScholarPubMed
Barnett, P, Matthews, H, Lloyd-Evans, B, et al.Compulsory community treatment to reduce readmission to hospital and increase engagement with community care in people with mental illness: a systematic review and meta-analysis. Lancet Psychiatr. 2018; 5(12): 10131022.CrossRefGoogle ScholarPubMed
Swartz, MS, Wilder, CM, Swanson, JW, et al.Assessing outcomes for consumers in New York’s assisted outpatient treatment program. Psychiatr Serv. 2010; 61(10): 976–81.CrossRefGoogle ScholarPubMed
Segal, SP, Rimes, L, Hayes, SL. The utility of outpatient commitment: reduced-risks of victimization and crime perpetration. Eur Psychiatry. 2019; 56: 97104.CrossRefGoogle ScholarPubMed

Usage data cannot currently be displayed.

Hostname: page-component-57c975d4c7-w49d2 Total loading time: 5.042 Render date: 2020-11-24T02:06:43.533Z Query parameters: { "hasAccess": "0", "openAccess": "0", "isLogged": "0", "lang": "en" } Feature Flags last update: Tue Nov 24 2020 01:52:28 GMT+0000 (Coordinated Universal Time) Feature Flags: { "metrics": false, "peerReview": true, "crossMark": true, "comments": false, "relatedCommentaries": false, "subject": true, "clr": false, "languageSwitch": false }

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Pharmacological treatment of violence in schizophrenia
Available formats
×

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

Pharmacological treatment of violence in schizophrenia
Available formats
×

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

Pharmacological treatment of violence in schizophrenia
Available formats
×
×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *