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Hostile / Aggressive Behavior David N. Osser, MD Associate Professor of Psychiatry Harvard Medical School Brockton Division of the VA Boston Healthcare System General Editor - Psychopharmacology Algorithm Project Harvard South Shore Residency Training Program

Clozapine for hostile/aggressive behavior: Best option Not FDA-approved specifically for aggressive behavior

Assaultive non-treatment-resistant inpatients 12-week RCT Clozapine Olanzapine Haloperidol Krakowski, M. I., Czobor, P., Citrome, L., Bark, N., & Cooper, T. B. (2006). Atypical antipsychotic agents in the treatment of violent patients with schizophrenia and schizoaffective disorder. Archives of General Psychiatry, 63(6), 622-629.

Assaultive non-treatment-resistant inpatients 12-week RCT Clozapine Olanzapine Haloperidol Krakowski, M. I., Czobor, P., Citrome, L., Bark, N., & Cooper, T. B. (2006). Atypical antipsychotic agents in the treatment of violent patients with schizophrenia and schizoaffective disorder. Archives of General Psychiatry, 63(6), 622-629.

Open-label randomized trial The EUFEST study Open-label randomized trial Volavka, J., Czobor, P., Derks, E. M., Bitter, I., Libiger, J., Kahn, R. S., & Fleischhacker, W. W. (2011). Efficacy of antipsychotic drugs against hostility in the European First-Episode Schizophrenia Trial (EUFEST). The Journal of clinical psychiatry, 72(7), 955-961.

Open-label randomized trial The EUFEST study Olanzapine Haloperidol Open-label randomized trial Amisulpride Quetiapine Ziprasidone Volavka, J., Czobor, P., Derks, E. M., Bitter, I., Libiger, J., Kahn, R. S., & Fleischhacker, W. W. (2011). Efficacy of antipsychotic drugs against hostility in the European First-Episode Schizophrenia Trial (EUFEST). The Journal of clinical psychiatry, 72(7), 955-961.

Open-label randomized trial The EUFEST study Olanzapine Haloperidol Open-label randomized trial Amisulpride Quetiapine Ziprasidone Volavka, J., Czobor, P., Derks, E. M., Bitter, I., Libiger, J., Kahn, R. S., & Fleischhacker, W. W. (2011). Efficacy of antipsychotic drugs against hostility in the European First-Episode Schizophrenia Trial (EUFEST). The Journal of clinical psychiatry, 72(7), 955-961.

Open-label randomized trial The EUFEST study Olanzapine Second best option Open-label randomized trial Volavka, J., Czobor, P., Derks, E. M., Bitter, I., Libiger, J., Kahn, R. S., & Fleischhacker, W. W. (2011). Efficacy of antipsychotic drugs against hostility in the European First-Episode Schizophrenia Trial (EUFEST). The Journal of clinical psychiatry, 72(7), 955-961.

The EUFEST study Second best option Consider metabolic effects Olanzapine Second best option Consider metabolic effects Open-label randomized trial Volavka, J., Czobor, P., Derks, E. M., Bitter, I., Libiger, J., Kahn, R. S., & Fleischhacker, W. W. (2011). Efficacy of antipsychotic drugs against hostility in the European First-Episode Schizophrenia Trial (EUFEST). The Journal of clinical psychiatry, 72(7), 955-961.

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