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Cavaliere VS, Glassman M, DiPaula BA, Mackowick M, Wehring HJ, Liu F, Chen S, Park J, Love RC, Richardson CM, Vyas G, Kearns AM, Kelly DL. Anti-aggressive effects of clozapine in involuntarily committed black patients with severe mental illness. Schizophr Res 2022; 243:163-169. [PMID: 35358857 DOI: 10.1016/j.schres.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/11/2022] [Accepted: 03/12/2022] [Indexed: 11/17/2022]
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. GOV IDENTIFIER NCT02404155.
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Affiliation(s)
- Vincent S Cavaliere
- University of Maryland School of Pharmacy, 20 N Pine St, Baltimore, MD 21201, USA
| | - Matthew Glassman
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, PO Box 21247, Catonsville, MD 21228, USA
| | - Bethany A DiPaula
- University of Maryland School of Pharmacy, 20 N Pine St, Baltimore, MD 21201, USA
| | - Marie Mackowick
- University of Maryland School of Pharmacy, 20 N Pine St, Baltimore, MD 21201, USA
| | - Heidi J Wehring
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, PO Box 21247, Catonsville, MD 21228, USA
| | - Fang Liu
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, PO Box 21247, Catonsville, MD 21228, USA
| | - Shuo Chen
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, PO Box 21247, Catonsville, MD 21228, USA
| | - Jaeboon Park
- University of Maryland School of Pharmacy, 20 N Pine St, Baltimore, MD 21201, USA
| | - Raymond C Love
- University of Maryland School of Pharmacy, 20 N Pine St, Baltimore, MD 21201, USA
| | - Charles M Richardson
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, PO Box 21247, Catonsville, MD 21228, USA
| | - Gopal Vyas
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, PO Box 21247, Catonsville, MD 21228, USA
| | - Ann Marie Kearns
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, PO Box 21247, Catonsville, MD 21228, USA
| | - Deanna L Kelly
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, PO Box 21247, Catonsville, MD 21228, USA.
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