Krakowski Menahem I, Czobor Pal, Citrome Leslie, Bark Nigel, Cooper Thomas B
Nathan Kline Institute for Psychiatric Research, Orangeburg, NY 10962, USA.
Arch Gen Psychiatry. 2006 Jun;63(6):622-9. doi: 10.1001/archpsyc.63.6.622.
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.
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.
Randomized, double-blind, parallel-group, 12-week trial. Physically assaultive subjects with schizophrenia or schizoaffective disorder who were inpatients in state psychiatric facilities were randomly assigned to treatment with clozapine (n = 37), olanzapine (n = 37), or haloperidol (n = 36).
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).
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.
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.
精神分裂症患者的暴力行为会延长住院时间，并妨碍他们融入社区。找到针对暴力行为的合适治疗方法至关重要。
比较两种非典型抗精神病药物氯氮平和奥氮平，以及它们与氟哌啶醇在治疗患有精神分裂症和分裂情感性障碍的有身体攻击行为患者的身体攻击及其他攻击性行为方面的疗效。
随机、双盲、平行组、为期12周的试验。在州立精神病设施住院的患有精神分裂症或分裂情感性障碍且有身体攻击行为的受试者被随机分配接受氯氮平治疗（n = 37）、奥氮平治疗（n = 37）或氟哌啶醇治疗（n = 36）。
通过改良外显攻击量表（MOAS）身体攻击得分衡量的身体攻击的次数和严重程度，以及通过MOAS总分衡量的所有攻击事件的次数和严重程度。通过阳性和阴性症状量表（PANSS）评估精神症状。
在通过MOAS身体攻击得分评估减少身体攻击的次数和严重程度以及通过MOAS总分评估减少总体攻击方面，氯氮平优于奥氮平和氟哌啶醇。在这两项MOAS指标上，奥氮平在减少攻击事件的次数和严重程度方面优于氟哌啶醇。在通过PANSS总分及3个PANSS分量表衡量的精神症状改善方面，3个药物组之间没有显著差异。
在减少攻击行为方面，氯氮平的疗效优于奥氮平，奥氮平的疗效优于氟哌啶醇。这种抗攻击作用似乎与这些药物的抗精神病和镇静作用无关。
