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    Anti-aggressive effects of clozapine in involuntarily committed black patients with severe mental illness.

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    Author
    Cavaliere, Vincent S
    Glassman, Matthew
    DiPaula, Bethany A
    Mackowick, Marie
    Wehring, Heidi J
    Liu, Fang
    Chen, Shuo
    Park, Jaeboon
    Love, Raymond C
    Richardson, Charles M
    Vyas, Gopal
    Kearns, Ann Marie
    Kelly, Deanna L
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    Date
    2022-03-28
    Journal
    Schizophrenia Research
    Publisher
    Elsevier
    Type
    Article
    
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    See at
    https://doi.org/10.1016/j.schres.2022.03.006
    Abstract
    Introduction: Patients with severe mental illness are falsely characterized as aggressive by the media, perpetuating stigma. While exaggerated, some patients with severe mental illness are more aggressive without treatment. Clozapine may have a unique anti-aggressive effect in patients with schizophrenia-related disorders, independent of antipsychotic or sedative effects. Limited data in forensic and involuntary committed patients is currently available. Purpose: This study evaluates clozapine's effects on hostility and aggression in court-ordered Black patients. Methods: This study analyzes a subgroup of Black patients from a larger prospective 24-week open-label clozapine study. All patients were involuntarily committed and enrolled from two participating state psychiatric hospitals. The primary outcome measured was total use of ‘as needed’ (PRN) or ‘immediate need’ (STAT) medications for aggression/hostility. Secondary outcomes included number and duration of seclusion and restraint (S/R) episodes, and changes in Brief Psychiatric Rating Scale (BPRS) hostility factor score. Results: Sixty-nine patients were included in our analysis. Significant reductions were noted in PRN/STAT medication use over time (χ2 = 6.90; p = 0.008) and the BPRS hostility factor score was reduced by 30% over the 24 weeks (F = 4.34, df = 62, p = 0.002). Conclusions: Treatment with clozapine effectively reduced hostility and aggression within this cohort of involuntarily committed Black patients with mental illness compared to baseline. Specifically, it helped lower the total number of PRN/STAT medication administrations and improved clinician-rated hostility factor scores on the BPRS. Our findings are pertinent as data in forensic settings is lacking and Black patients have been infrequently included in large prospective clinical trials with clozapine. ClinicalTrials.gov identifier: NCT02404155.
    Rights/Terms
    Copyright © 2022. Published by Elsevier B.V.
    Keyword
    African Americans
    Aggression
    Clozapine
    Forensic psychiatry
    Schizophrenia
    Violence
    Identifier to cite or link to this item
    http://hdl.handle.net/10713/18532
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.schres.2022.03.006
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