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 .
Depression and impulsivity as pathways to violence: implications for antiaggressive treatment.
BACKGROUND Difficulties with affect regulation and impulse control have a strong influence on violence . The objective of this study was to determine whether baseline depression and impulsivity predict aggression and whether they predict differential response to antiaggressive treatment . This is important , as we lack knowledge as to the selection of antipsychotics for the treatment of aggression . METHODS Physically aggressive in patients with schizophrenia who received an evaluation of depression and impulsivity at baseline were r and omly assigned in a double-blind , parallel group , 12-week trial to clozapine , olanzapine , or haloperidol . Trait impulsivity was measured by the Barratt Impulsiveness Scale ; depression by the Positive and Negative Syndrome Scale Depression factor . The number and severity of aggressive events , as measured by the Modified Overt Aggression Scale ( MOAS ) , were the outcome measures . RESULTS Baseline depression and impulsivity predicted higher levels of aggression , as measured by the MOAS total score , over the 12-week treatment period across all 3 medication groups . In addition , there was a strong interaction effect between baseline depression/impulsivity and medication grouping in predicting MOAS score . In particular , when higher depression and impulsivity were present at baseline , patients on haloperidol presented with more aggression than patients on the other 3 medications . CONCLUSIONS Depression and impulsivity are important predictors of aggression and of differential response to antiaggressive treatment . This is most likely due to the medications ' dissimilar neurotransmitter profiles . By identifying patients who will respond better to a given medication , we will be able to develop individualized strategies for the treatment of violent behavior
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 .