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 .
Executive function predicts response to antiaggression treatment in schizophrenia: a randomized controlled trial.
OBJECTIVE Despite extensive experience with antipsychotic medications , we have limited capacity to predict which patients will benefit from which medications and for what symptoms . Such prediction is of particular importance for the proper treatment of violence . Our goal was to determine whether executive function predicts outcome of treatment for aggressive behavior and whether such prediction varies across medication groups . METHOD Ninety-nine physically aggressive in patients ( aged 18 - 60 years ) with schizophrenia or schizoaffective disorder ( diagnosed according to DSM-IV ) who completed tests of executive function were r and omly assigned in a double-blind , parallel-group , 12-week trial to clozapine ( n = 32 ) , olanzapine ( n = 32 ) , or haloperidol ( n = 35 ) . The number and severity of aggressive events as measured by the Modified Overt Aggression Scale ( MOAS ) were the outcome measures . Psychopathology and medication side effects were also assessed . The study was conducted from 1999 to 2004 . RESULTS Poor executive function predicted higher levels of aggression , as measured by MOAS scores over the 12-week period , in all 3 medication groups ( F(1,98 ) = 222.2 , P < .0001 ) . There was , however , a significant interaction effect between medication grouping and executive function ( F(1,98 ) = 15.32 , P < .001 ) : clozapine exerted an antiaggression effect even in the presence of executive dysfunction . CONCLUSIONS Executive function was a strong predictor of response to antiaggression treatment in all medication groups , but clozapine still retained clinical efficacy in the presence of poor executive functioning . Olanzapine was particularly efficacious in the absence of executive dysfunction . These findings have important implication s for a targeted approach to the treatment of aggression in patients with schizophrenia . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01123408
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 .