Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States of America.
New York Medical College, Valhalla, NY, United States of America.
Schizophr Res. 2024 Jun;268:265-281. doi: 10.1016/j.schres.2023.11.008. Epub 2024 Jan 30.
Although uncommon, the risk of aggression and violence is greater in people with schizophrenia than in the general population. Clozapine is the "gold standard" pharmacologic treatment for the management of persistent agitation and aggression in people with schizophrenia and is consistently recommended by guidelines and reviews for this purpose. Although clozapine is indicated for treatment-resistant schizophrenia based on its superior efficacy, studies have proposed that clozapine may have specific properties that ameliorate aggression and hostility that are distinct from its antipsychotic effects. A literature review was conducted on June 3, 2023, using the US National Library of Medicine's PubMed resource to identify articles focusing on clozapine for the treatment of aggression, violence, and/or hostility in patients with schizophrenia or schizoaffective disorder. The majority of evidence, including from randomized control trials, supports the utilization of clozapine as maintenance treatment for persistent aggressive behavior in patients with schizophrenia, and supports that its anti-aggressive effects may be independent from its antipsychotic properties (e.g. - treatment of hallucinations and delusions). Future randomized control studies evaluating clozapine and clozapine serum levels with aggression as the primary outcome would be of benefit.
虽然不常见，但精神分裂症患者的攻击和暴力风险高于一般人群。氯氮平是治疗精神分裂症患者持续激越和攻击的“金标准”药物治疗方法，并且一直被指南和综述推荐用于这一目的。尽管氯氮平因其疗效优越而被用于治疗抵抗性精神分裂症，但研究表明，氯氮平可能具有特定的特性，可以改善攻击和敌意，这与它的抗精神病作用不同。2023 年 6 月 3 日，我们使用美国国立医学图书馆的 PubMed 资源进行了文献回顾，以确定聚焦于氯氮平治疗精神分裂症或分裂情感障碍患者攻击、暴力和/或敌意的文章。大多数证据，包括随机对照试验，支持将氯氮平作为精神分裂症患者持续攻击行为的维持治疗，并且支持其抗攻击作用可能独立于其抗精神病特性（例如，治疗幻觉和妄想）。未来评估氯氮平及其血清水平与攻击作为主要结局的随机对照研究将是有益的。
