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Randomised clinical trial comparing oral versus depot formulations of zuclopenthixol in patients with schizophrenia and previous violence

Published online by Cambridge University Press:  16 April 2020

C. Arango ,
I. Bombín ,
T. González-Salvador ,
I. García-Cabeza  and
J. Bobes
C. Arango*
Affiliation:
Hospital General Universitario Gregorio Marañón, Department of Psychiatry, C/Ibiza, 43, 28009Madrid, Spain
I. Bombín
Affiliation:
Hospital General Universitario Gregorio Marañón, Department of Psychiatry, C/Ibiza, 43, 28009Madrid, Spain
T. González-Salvador
Affiliation:
Centro de Salud Mental de Colmenar Viejo, Madrid, Spain
I. García-Cabeza
Affiliation:
Hospital General Universitario Gregorio Marañón, Department of Psychiatry, C/Ibiza, 43, 28009Madrid, Spain
J. Bobes
Affiliation:
Department of Medicine-Psychiatry, Universidad de Oviedo, C/Julián Clavería 6, 33006Oviedo, Spain
*
*Corresponding author. Tel.: +34 91 667 776419; fax: +34 91 426 5005. E-mail address:carango@mce.hggm.es (C. Arango).
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Abstract

Objective

The aim of this longitudinal study was to determine whether the depot formulation of an antipsychotic reduces violence in outpatients with schizophrenia as compared to oral administration of the same antipsychotic.

Methods

Forty-six previously violent patients with schizophrenia were randomised to receive treatment with oral or depot zuclopenthixol for 1 year. Clinicians interviewed patients at baseline and every month thereafter to assess treatment adherence. An interviewer blinded to treatment assignments interviewed an informant about any violent behaviour during the previous month.

Results

Violence during the follow-up year was inversely proportional to treatment adherence, better compliance, and greater reduction of positive symptoms. Lower frequency of violent acts was observed in the depot group. The level of insight at baseline was not significantly associated with violence recidivism. Regardless of route of administration, treatment non-adherence was the best predictor of violence.

Conclusions

Some patients with schizophrenia and prior violent behaviour may benefit from the depot formulation of antipsychotic medication.

Keywords

SchizophreniaViolenceTreatment adherenceDepot medication
Type
Original article
Information
European Psychiatry , Volume 21 , Issue 1 , January 2006 , pp. 34 - 40
Copyright
Copyright © Elsevier SAS 2006

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References

Arseneault, LMoffitt, TECaspi, ATaylor, PJSilva, PAMental disorders and violence in a total birth cohort: results from the Dunedin study. Arch. Gen. Psychiatry 2000;57(10):979–986.CrossRefGoogle Scholar
Arango, CCalcedo Barba, AGonzalez, SCalcedo Ordonez, AViolence in inpatients with schizophrenia: a prospective study. Schizophr. Bull. 1999;25(3):493–503.CrossRefGoogle ScholarPubMed
Amador, XFStrauss, DHYale, SAFlaum, MMEndicott, JGorman, JMAssessment of insight in psychosis. Am. J. Psychiatry 1993;150(6):873–879.Google ScholarPubMed
Amador, XFStrauss, DHPoor insight in schizophrenia. Psychiatr. Q. 1993;64(4):305–318.CrossRefGoogle Scholar
Appelbaum, PSRobbins, PCMonahan, JViolence and delusions: data from the MacArthur Violence Risk Assessment Study. Am. J. Psychiatry 2000;157(4):566–572.CrossRefGoogle ScholarPubMed
Baastrup, PCAlhfors, UGBjerkenstedt, LDencker, SJFensbo, CGravem, Aet al.A controlled Nordic multicentre study of zuclopenthixol acetate in oil solution, haloperidol and zuclopenthixol in the treatment of acute psychosis. Acta Psychiatr. Scand. 1993;87(1):48–58.CrossRefGoogle ScholarPubMed
Bartels, SJDrake, REWallach, MAFreeman, DHCharacteristic hostility in schizophrenic outpatients. Schizophr. Bull. 1991;17(1):163–171.CrossRefGoogle ScholarPubMed
Brennan, PAMednick, SAHodgins, SMajor mental disorders and criminal violence in a Danish birth cohort. Arch. Gen. Psychiatry 2000;57(5):494–500.CrossRefGoogle Scholar
Buckley, PFHrouda, DRFriedman, LNoffsinger, SGResnick, PJCamlin-Shingler, KInsight and its relationship to violent behavior in patients with schizophrenia. Am. J. Psychiatry 2004;161(9):1712–1714.CrossRefGoogle ScholarPubMed
Hodgins, SMednick, SABrennan, PASchulsinger, FEngberg, MMental disorder and crime. Evidence from a Danish birth cohort. Arch. Gen. Psychiatry 1996;53(6):489–496.CrossRefGoogle ScholarPubMed
Hodgins, SThe etiology and development of offending among persons with major mental disorders: some preliminary findings. In: Hodgins, S, editors. Violence among the mentally ill III: effective treatments and management strategies Dordrecht, The Netherlands: Kluwer Academic Publishers; 2000. p. 89–116.CrossRefGoogle Scholar
Hodgins, SHiscoke, ULFreese, RThe antecedents of aggressive behavior among men with schizophrenia: a prospective investigation of patients in community treatment. Behav. Sci. Law 2003;21(4):523–546.CrossRefGoogle ScholarPubMed
Junginger, JPsychosis and violence: the case for a content analysis of psychotic experience. Schizophr. Bull. 1996;22(1):91–103.CrossRefGoogle ScholarPubMed
Joyal, CCPutkonen, APaavola, PTiihonen, JCharacteristics and circumstances of homicidal acts committed by offenders with schizophrenia. Psychol. Med. 2004;34(3):433–442.CrossRefGoogle ScholarPubMed
Kane, JMCompliance issues in outpatient treatment. J. Clin. Psychopharmacol. 1985;5(3 Suppl):22S–27S.CrossRefGoogle ScholarPubMed
Kay, SRFiszbein, AOpler, LAThe positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr. Bull. 1987;13(2):261–276.CrossRefGoogle Scholar
Kay, SRWolkenfeld, FMurrill, LMProfiles of aggression among psychiatric patients. I. Nature and prevalence. J. Nerv. Ment. Dis. 1988;176(9):539–546.CrossRefGoogle ScholarPubMed
Krakowski, MIConvit, AJaeger, JLin, SVolavka, JInpatient violence: trait and state. J. Psychiatr. Res. 1989;23(1):57–64.CrossRefGoogle ScholarPubMed
Krakowski, MCzobor, PChou, JCCourse of violence in patients with schizophrenia: relationship to clinical symptoms. Schizophr. Bull. 1999;25(3):505–517.CrossRefGoogle ScholarPubMed
Krakowski, MISchizophrenia with aggressive and violent behaviors. Psychiatr. Ann. 2005;35:45–49.Google Scholar
Lingjaerde, OAhlfors, UGBech, PDencker, SJElgen, KThe UKU side effect rating scale. A new comprehensive rating scale for psychotropic drugs and a cross-sectional study of side effects in neuroleptic-treated patients. Acta Psychiatr. Scand. Suppl. 1987;334:1–100.CrossRefGoogle Scholar
Link, BGAndrews, HCullen, FTThe violent and illegal behavior of mental patients reconsidered. Am. Sociol. Rev. 1992;57:275–292.CrossRefGoogle Scholar
Marzuk, PMViolence, crime, and mental illness. How strong a link?. Arch. Gen. Psychiatry 1996;53(6):481–486.Google Scholar
Nolan, KAVolavka, JMohr, PCzobor, PPsychopathy and violent behavior among patients with schizophrenia or schizoaffective disorder. Psychiatr. Serv. 1999;50(6):787–792.CrossRefGoogle ScholarPubMed
Steinert, TSippach, TGebhardt, RPHow common is violence in schizophrenia despite neuroleptic treatment?. Pharmacopsychiatry 2000;33(3):98–102.CrossRefGoogle ScholarPubMed
Swanson, JWHolzer, CEGanju, VKJono, RTViolence and psychiatric disorder in the community: evidence from the Epidemiologic Catchment Area surveys. Hosp. Community Psychiatry 3rd 1990;41(7):761–770.Google ScholarPubMed
Swanson, JWSwartz, MSElbogen, EBVan Dorn, RAReducing violence risk in persons with schizophrenia: olanzapine versus risperidone. J. Clin. Psychiatry 2004;65(12):1666–1673.CrossRefGoogle ScholarPubMed
Swanson, JWSwartz, MSElbogen, EBVan Dorn, RABuckley, PFHrouda, DRet al.Reducing violence risk in persons with schizophrenia: olanzapine versus risperidone. Insight and its relationship to violent behavior in patients with schizophrenia. Effectiveness of atypical antipsychotic medications in reducing violent behavior among persons with schizophrenia in community-based treatment. Substance misuse, psychiatric disorder and violent and disturbed behaviour. Dual diagnosis of substance abuse in schizophrenia: prevalence and impact on outcomes. Taking the wrong drugs: the role of substance abuse and medication noncompliance in violence among severely mentally ill individuals. Schizophrenia, violence, clozapine and risperidone: a review. The Special Hospitals Treatment Resistant Schizophrenia Research Group. Violence and paranoid schizophrenia. Long-term high-dose neuroleptic treatment: who gets it and why? Outpatient management of schizophrenia. J. Clin. Psychiatry 2004;65(12):1666–1673.CrossRefGoogle Scholar
Swartz, MSSwanson, JWHiday, VABorum, RWagner, RBurns, BJTaking the wrong drugs: the role of substance abuse and medication noncompliance in violence among severely mentally ill individuals. Soc. Psychiatry Psychiatr. Epidemiol. 1998;33(Suppl 1):S75–S80.CrossRefGoogle ScholarPubMed
Taylor, PJMotives for offending among violent and psychotic men. Br. J. Psychiatry 1985;147:491–498.CrossRefGoogle ScholarPubMed
Torrey, EFViolent behavior by individuals with serious mental illness. Hosp. Community Psychiatry 1994;45(7):653–662.Google ScholarPubMed
Torrey, EFZdanowicz, MOutpatient commitment: what, why, and for whom. Psychiatr. Serv. 2001;52(3):337–341.CrossRefGoogle ScholarPubMed
Tiihonen, JIsohanni, MRasanen, PKoiranen, MMoring, JSpecific major mental disorders and criminality: a 26-year prospective study of the 1966 northern Finland birth cohort. Am. J. Psychiatry 1997;154(6):840–845.Google ScholarPubMed
Volavka, JKrakowski, MSchizophrenia and violence. Psychol. Med. 1989;19(3):559–562.CrossRefGoogle ScholarPubMed
Volavka, JNeurobiology of violence. 2nd ed. Washington: American Psychiatric Publishing; 2002.Google Scholar
Wallace, CMullen, PEBurgess, PCriminal offending in schizophrenia over a 25 years period marked by deinstitutionalization and increasing prevalence of comorbid substance use disorders. Am. J. Psychiatry 2004;161(4):716–727.CrossRefGoogle Scholar
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