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2. 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

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

4. 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),

5. 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),

6. 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),

7. 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),

8. 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),

9. 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),

10. 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),

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