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Clozapine for Treatment-Refractory Aggressive Behavior

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Abstract

Emergency psychiatry has the main role of resolving suicidal behavior and aggression. These severe psychiatric symptoms can be found in many psychiatric disorders such as schizophrenia, bipolar disorder, major depression, personality disorders, cognitive disorders, intellectual disability and substance abuse. Although indications for the use of antipsychotics are limited to a specific group of diseases, they are frequently used as rescue medication in high-risk or nonresponsive cases. Clozapine, the gold standard for TRS (treatment resistant schizophrenia) is effective in controlling aggression. The aim of the research was to identify the use of clozapine for treatment-refractory aggressive behavior in psychiatric emergency. A retrospective study based on the paper files of patients admitted between 2010 and 2019 in the Clinical Hospital of Psychiatry and Neurology of Brasov, Romania. Were included all the patients admitted as a psychiatric emergency and treated with clozapine for aggressive behavior. The hospital is an academic institution with 150 beds for acute patients, serving an area of over 600,000 inhabitants. It is the main public institution where patients with psychiatric emergencies are hospitalized. Off 19,000 patients admitted during the study period, 504 patients (2,4%) with a diagnosis other than schizophrenia or schizoaffective disorder received clozapine for aggressiveness (89.5%). The first four diagnoses identified were bipolar disorder (n = 172), intellectual disability (n = 128), cognitive impairment (n = 112), and personality disorder (n = 92). Other disorders identified but with a smaller number of cases were major depressive disorder (n = 3), adjustment disorders (n = 2), delusional disorder (n = 2), obsessive compulsive disorder (n = 2) and postpartum psychosis (n = 1). Clozapine was used as 3rd or 4th choice. The dose was greater for manic patients (350.29 ± 98.01 mg/day) compared with all the other diagnoses. Clozapine was effective and safe in cases of patients with treatment-refractory aggressive behavior.

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Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request with the authorization of the hospital Ethics Committee.

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Authors and Affiliations

  1. 1st and 3rd Clinical Departments, Clinical Hospital of Psychiatry and Neurology of Brasov, Brasov, Romania

    Teodorescu Andreea, Ifteni Petru, Ana Aliana Miron & Petric Paula-Simina

  2. Faculty of Medicine, Transilvania University of Brasov, 56 Nicolae Bălcescu Str., 500019, Brasov, Romania

    Dima Lorena

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  1. Teodorescu Andreea
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  2. Ifteni Petru
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  3. Ana Aliana Miron
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  4. Petric Paula-Simina
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  5. Dima Lorena
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Contributions

TA and IP conceived the study; IP and PPS performed the statistical analyses; TA, IP, MAA and DL wrote the paper; and all authors were involved in the writing and critical appraisal of methods and approved the final manuscript.

Corresponding author

Correspondence to Ifteni Petru.

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Conflict of Interest

In the last 3 years, TA and IP have received honoraria for consulting or lectures from Lundbeck, Janssen and Angelini.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Research Involving Human Participants and/or Animals

This research present results of clozapine efficacy in another psychiatric disease except schizophrenia and schizoaffective disorder. This treatment is approved by the hospital’s protocols for psychiatric emergencies.

Informed Consent

The written informed consent for this research was obtain from all patients at admission.

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Andreea, T., Petru, I., Miron, A.A. et al. Clozapine for Treatment-Refractory Aggressive Behavior. Psychiatr Q 92, 721–733 (2021). https://doi.org/10.1007/s11126-020-09839-x

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  • DOI: https://doi.org/10.1007/s11126-020-09839-x

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