This perspective has implications for the management
of aggressive behavior in schizophrenia. First, prevention
and treatment of comorbid substance use disorders
should be an integral part of care for schizophrenia
patients. However, we should not expect that this will
be adequate for all cases of aggressive behavior in
schizophrenia. Early treatment with clozapine or perhaps
another antipsychotic with proven antiaggressive action
is indicated for persistent aggression in schizophrenia.5
The results of the Krakowski study5 as well as emerging
evidence30 suggest that olanzapine might be a candidatefor such indication. Finally, a substantial proportion of
schizophrenia patients will continue with their aggressive
behavior in spite of treatments for substance abuse and
psychosis. Many of these treatment resistant patients
will have a history of conduct disorder and exhibit current
features of psychopathy. Until recently, there was little, we
could offer these patients. However, recently developed
long-term psychosocial interventions using cognitive
behavioral approaches are surprisingly effective in
reducing persistent aggressive behavior in psychotic
patients.41 These programs are expensive to administer.
We suggest that these approaches should receive more
support.
This perspective has implications for the management
of aggressive behavior in schizophrenia. First, prevention
and treatment of comorbid substance use disorders
should be an integral part of care for schizophrenia
patients. However, we should not expect that this will
be adequate for all cases of aggressive behavior in
schizophrenia. Early treatment with clozapine or perhaps
another antipsychotic with proven antiaggressive action
is indicated for persistent aggression in schizophrenia.5
The results of the Krakowski study5 as well as emerging
evidence30 suggest that olanzapine might be a candidatefor such indication. Finally, a substantial proportion of
schizophrenia patients will continue with their aggressive
behavior in spite of treatments for substance abuse and
psychosis. Many of these treatment resistant patients
will have a history of conduct disorder and exhibit current
features of psychopathy. Until recently, there was little, we
could offer these patients. However, recently developed
long-term psychosocial interventions using cognitive
behavioral approaches are surprisingly effective in
reducing persistent aggressive behavior in psychotic
patients.41 These programs are expensive to administer.
We suggest that these approaches should receive more
support.
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