Chronic violence and hostility in schizophrenic patients represent a serious problem which impacts on the perpetrators, other patients and caregivers. In preliminary studies, we have identified a group of schizophrenic patients who evidence persistent violence and hostility linked to specific schizophrenic symptoms. These patients are responsible for a high percentage of all inpatient assaults. The literature suggests that clozapine (CLO) has specific anti- aggressive effects and it improves psychotic symptoms and cognitive impairments similar to those which we identified in these patients. Olanzapine's (OLZ) without the latter's potentially serious side effects suggests that it may have an important place in the treatment of these patients. We will examine the examine the comparative efficacy of CLO, OLZ and standard agent haloperidol (HAL) in the treatment of persistent. We will also how underlying symptoms and deficits are associated with persistent violence and how they improve with each of these three treatments. Violent patients (N=212) will enter a 12-week clinical trial in which they will be randomized to either CLO, OLZ or HAL under double-bind conditions. Outcomes measures include the Modified Overt Aggression Scale, the Buss-HAL under double-blind conditions. Outcomes measured include the Modified Overt Aggression Scale, the Buss-Durkee Hostility inventory, and the NOSIE. Patients' reduction in psychotic symptoms will be assessed by PANSS and CGI. Reduction in cognitive impairment will be assessed by the Wisconsin Card Sorting Test, in impulsivity by the Barrat Impulsiveness scale. It is hypothesized that: 1) the effects of CLO on physical assaults, hostility and social functioning will be superior to those of OLZ, which, in turn, will be superior to HAL's. 2) Improvement in the outcome variables-violence, hostility and social functioning-will be related to improvement in underlying symptoms, i.e. ability to utilize environmental feedback, impulsivity, and psychosis. Similar to the outcome measures, these symptoms will improve more with CLO than OLZ and more with OLZ than HAL.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH058341-05
Application #
6629217
Study Section
Treatment Assessment Review Committee (TA)
Program Officer
Babcock, Debra J
Project Start
1999-02-01
Project End
2005-07-31
Budget Start
2003-02-01
Budget End
2005-07-31
Support Year
5
Fiscal Year
2003
Total Cost
$282,016
Indirect Cost
Name
Nathan Kline Institute for Psychiatric Research
Department
Type
DUNS #
167204762
City
Orangeburg
State
NY
Country
United States
Zip Code
10962
Krakowski, Menahem I; Czobor, Pal (2012) Executive function predicts response to antiaggression treatment in schizophrenia: a randomized controlled trial. J Clin Psychiatry 73:74-80
Krakowski, Menahem; Czobor, Pal (2011) Cholesterol and cognition in schizophrenia: a double-blind study of patients randomized to clozapine, olanzapine and haloperidol. Schizophr Res 130:27-33
Krakowski, Menahem I; Czobor, Pal (2010) A prospective longitudinal study of cholesterol and aggression in patients randomized to clozapine, olanzapine, and haloperidol. J Clin Psychopharmacol 30:198-200
Krakowski, Menahem; Czobor, Pal; Citrome, Leslie (2009) Weight gain, metabolic parameters, and the impact of race in aggressive inpatients randomized to double-blind clozapine, olanzapine or haloperidol. Schizophr Res 110:95-102
Krakowski, Menahem I; Czobor, Pal; Nolan, Karen A (2008) Atypical antipsychotics, neurocognitive deficits, and aggression in schizophrenic patients. J Clin Psychopharmacol 28:485-93
Krakowski, Menahem I; Czobor, Pal; Citrome, Leslie et al. (2006) Atypical antipsychotic agents in the treatment of violent patients with schizophrenia and schizoaffective disorder. Arch Gen Psychiatry 63:622-9
Krakowski, Menahem I; Czobor, Pal (2004) Psychosocial risk factors associated with suicide attempts and violence among psychiatric inpatients. Psychiatr Serv 55:1414-9
Krakowski, Menahem; Czobor, Pal (2004) Gender differences in violent behaviors: relationship to clinical symptoms and psychosocial factors. Am J Psychiatry 161:459-65
Krakowski, Menahem; Czobor, Pal (2004) Suicide and violence in patients with major psychiatric disorders. J Psychiatr Pract 10:233-8