Glazer W M, Dickson R A
Department of Psychiatry, Harvard Medical School, and Massachusetts General Hospital, Boston, USA.
J Clin Psychiatry. 1998;59 Suppl 3:8-14.
Violence and persistent aggression are serious problems in the general population and among certain psychiatric patients. Violence and persistent aggression have been associated with suicidal ideation and substance abuse, characteristics of chronically ill, and in many instances, treatment-resistant schizophrenia individuals. Assessment of dangerousness in psychiatric patients involves evaluation of sociodemographic and clinical factors. A substantial number of neurologic and psychiatric disorders are associated with pathologic anger and aggression; of these, the association between schizophrenia and violence/aggression is the best described. Neurotransmitters that have been implicated in aggressive and violent behavior include serotonin, norepinephrine, and dopamine. Current pharmacotherapy of pathologic aggression involves the use of multiple agents on a trial-and-error basis, with varying degrees of response. Unfortunately, this approach subjects patients to numerous side effects, including the extrapyramidal symptoms associated with the use of conventional antipsychotics. This paper will review evidence for the efficacy of clozapine in the treatment of aggression and violence in the treatment-refractory patient. The reduction in violence and persistent aggression with clozapine treatment should improve the chances for integration of the schizophrenia patient into the community and provide cost savings to society.
暴力和持续攻击行为在普通人群以及某些精神疾病患者中都是严重问题。暴力和持续攻击行为与自杀观念、物质滥用、慢性病特征相关，并且在很多情况下，与难治性精神分裂症患者有关。对精神疾病患者的危险性评估涉及对社会人口学和临床因素的评估。大量神经和精神疾病与病理性愤怒和攻击行为相关；其中，精神分裂症与暴力/攻击行为之间的关联描述得最为详尽。与攻击和暴力行为有关的神经递质包括血清素、去甲肾上腺素和多巴胺。目前对病理性攻击行为的药物治疗是在试错基础上使用多种药物，反应程度各不相同。不幸的是，这种方法会使患者出现众多副作用，包括与使用传统抗精神病药物相关的锥体外系症状。本文将综述氯氮平治疗难治性患者攻击和暴力行为疗效的证据。氯氮平治疗使暴力和持续攻击行为减少，应会增加精神分裂症患者融入社区的机会，并为社会节省成本。
