From the Guidelines
Atypical antipsychotics are effective for treating violence and aggression.
Key Points
- Atypical antipsychotics, such as risperidone, olanzapine, and quetiapine, are recommended for the control of problematic delusions, hallucinations, severe psychomotor agitation, and combativeness 1.
- These medications have a diminished risk of developing extrapyramidal symptoms and tardive dyskinesia compared to typical antipsychotic agents 1.
- Risperidone is often used at a low dosage, with an initial dosage of 0.25 mg per day at bedtime and a maximum of 2 to 3 mg per day, usually twice daily in divided doses 1.
- Olanzapine is generally well-tolerated, with an initial dosage of 2.5 mg per day at bedtime and a maximum of 10 mg per day, usually twice daily in divided doses 1.
- The use of atypical antipsychotics is supported by studies showing their efficacy in reducing aggression and violence in patients with intellectual disabilities and schizophrenia 1.
- The American Psychiatric Association recommends the use of antipsychotic medication, including atypical antipsychotics, for the treatment of schizophrenia and aggressive behavior 1.
Important Considerations
- Non-pharmacological interventions, such as anger management and problem-solving programs, should be considered as the primary response to aggressive behavior, with atypical antipsychotics used as adjunctive therapy 1.
- The use of atypical antipsychotics should be carefully monitored for effectiveness and side effects, with regular assessments of the patient's symptoms and behavior 1.
- The selection of atypical antipsychotics should be based on the individual patient's needs and medical history, with consideration of factors such as dosage, side effects, and potential interactions with other medications 1.
From the Research
Antipsychotic Medications for Treating Violence and Aggression
- Clozapine has been shown to be effective in reducing violent and aggressive behavior in patients with schizophrenia and schizoaffective disorder 2, 3.
- Olanzapine has also been found to be effective in reducing aggressive behavior, although to a lesser extent than clozapine 2.
- Risperidone has been shown to be superior to classical antipsychotics and placebo in the treatment of hostility and aggression in schizophrenia 4.
- Clozapine has also been found to be effective in reducing violence and aggression in patients with antisocial personality disorder and high psychopathic traits 5.
Comparison of Antipsychotic Medications
- Clozapine was found to be superior to olanzapine and haloperidol in reducing physical assaults and overall aggression in patients with schizophrenia and schizoaffective disorder 2.
- Olanzapine was found to be superior to haloperidol in reducing aggressive behavior, but not as effective as clozapine 2.
- Risperidone was found to be more effective than classical antipsychotics and placebo in reducing hostility and aggression in schizophrenia, although the effect size was small 4.
Specific Patient Populations
- Clozapine has been found to be effective in reducing violence and aggression in patients with treatment-resistant schizophrenia 3.
- Clozapine has also been found to be effective in reducing violence and aggression in patients with antisocial personality disorder and high psychopathic traits 5.
- Risperidone has been found to be effective in reducing hostility and aggression in patients with schizophrenia, regardless of treatment resistance status 4.