MAIN RESULTS We have no good- quality evidence of the absolute effectiveness of haloperidol for people with long-term aggression .
When haloperidol was compared with olanzapine or clozapine , skewed data ( n=83 ) at high risk of bias suggested some advantage in terms of scale scores of unclear clinical meaning for olanzapine/clozapine for ' total aggression ' .
Although there were some data for the outcomes listed above , there were no data on most of the binary outcomes and none on service outcomes ( use of hospital/police ) , satisfaction with treatment , acceptance of treatment , quality of life or economics .
BACKGROUND Psychotic disorders can lead some people to become agitated .
Characterised by restlessness , excitability and irritability , this can result in verbal and physically aggressive behaviour - and both can be prolonged .
Aggression within the psychiatric setting imposes a significant challenge to clinicians and risk to service users ; it is a frequent cause for admission to inpatient facilities .
If people continue to be aggressive it can lengthen hospitalisation .
Haloperidol is used to treat people with long-term aggression .
OBJECTIVES To examine whether haloperidol alone , administered orally , intramuscularly or intravenously , is an effective treatment for long-term/persistent aggression in psychosis .
Atypical antipsychotic agents in the treatment of violent patients with schizophrenia and schizoaffective disorder.
CONTEXT Violent behavior of patients with schizophrenia prolongs hospital stay and interferes with their integration into the community . Finding appropriate treatment of violent behaviors is of primary importance . OBJECTIVE To compare the efficacy of 2 atypical antipsychotic agents , clozapine and olanzapine , with one another and with haloperidol in the treatment of physical assaults and other aggressive behaviors in physically assaultive patients with schizophrenia and schizoaffective disorder . DESIGN AND SETTING R and omized , double-blind , parallel-group , 12-week trial . Physically assaultive subjects with schizophrenia or schizoaffective disorder who were in patients in state psychiatric facilities were r and omly assigned to treatment with clozapine ( n = 37 ) , olanzapine ( n = 37 ) , or haloperidol ( n = 36 ) . MAIN OUTCOME MEASURES Number and severity of physical assaults as measured by the Modified Overt Aggression Scale ( MOAS ) physical aggression score and the number and severity of all aggressive events as measured by the MOAS overall score . Psychiatric symptoms were assessed through the Positive and Negative Syndrome Scale ( PANSS ) . RESULTS Clozapine was superior to both olanzapine and haloperidol in reducing the number and severity of physical assaults as assessed by the MOAS physical aggression score and in reducing overall aggression as measured by the MOAS total score . Olanzapine was superior to haloperidol in reducing the number and severity of aggressive incidents on these 2 MOAS measures . There were no significant differences among the 3 medication groups in improvement of psychiatric symptoms as measured by the PANSS total score and the 3 PANSS subscales . CONCLUSIONS Clozapine shows greater efficacy than olanzapine and olanzapine greater efficacy than haloperidol in reducing aggressive behavior . This antiaggressive effect appears to be separate from the antipsychotic and sedative action of these medications
MAIN RESULTS We have no good- quality evidence of the absolute effectiveness of haloperidol for people with long-term aggression .
When haloperidol was compared with olanzapine or clozapine , skewed data ( n=83 ) at high risk of bias suggested some advantage in terms of scale scores of unclear clinical meaning for olanzapine/clozapine for ' total aggression ' .
Although there were some data for the outcomes listed above , there were no data on most of the binary outcomes and none on service outcomes ( use of hospital/police ) , satisfaction with treatment , acceptance of treatment , quality of life or economics .
BACKGROUND Psychotic disorders can lead some people to become agitated .
Characterised by restlessness , excitability and irritability , this can result in verbal and physically aggressive behaviour - and both can be prolonged .
Aggression within the psychiatric setting imposes a significant challenge to clinicians and risk to service users ; it is a frequent cause for admission to inpatient facilities .
If people continue to be aggressive it can lengthen hospitalisation .
Haloperidol is used to treat people with long-term aggression .
OBJECTIVES To examine whether haloperidol alone , administered orally , intramuscularly or intravenously , is an effective treatment for long-term/persistent aggression in psychosis .