Clozapine for Treatment-Refractory Aggressive Behavior
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Clozapine for Treatment-Refractory Aggressive Behavior Teodorescu Andreea 1 & Ifteni Petru 1 & Ana Aliana Miron 1 & Petric Paula-Simina 1 & Dima Lorena 2 Accepted: 30 August 2020/ # Springer Science+Business Media, LLC, part of Springer Nature 2020
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. Keywords Clozapine . Emergency psychiatry . Treatment-refractory . Aggressiveness
* Ifteni Petru [email protected] Extended author information available on the last page of the article
Psychiatric Quarterly
Introduction Aggression and violence are often associated with mental illnesses and common in schizophrenia, mood disorders and drug abuse disorder [1–3]. The management of these symptoms are difficult in emergency psychiatric units especially when patients belong to the vulnerable categories such as individuals with intellectual disability (ID) or people with major cognitive disorder (dementia). The concomitant use of alcohol and/or drugs is identified in patients with acute agitation or aggressive behaviors. There
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