The Use of Clozapine in the Treatment of Aggressive Schizophrenia

The atypical antipsychotic drug clozapine was introduced to clinical practice in 1972. It is a dibenzodiazepine derivative with, among other known receptor site activities, a relatively high D1/D2 receptor affinity ratio. The serious side effects of bone marrow suppression and agranulocytosis delayed the acceptance of clozapine into common clinical practice but scrupulous application of a monitoring protocol led to adequate protection from these side effects. There is now a broad consensus about the benefits of clozapine which supports the use of clozapine as a first-line treatment of schizophrenia. There is good evidence that relapse and rehospitalization drop to 22% of the incidence in preclozapine treatment patients. The majority of responders are identified within 4 months of treatment. Clozapine has been demonstrated to be an effective treatment for neuroleptic refractory patients. Forty percent of clozapine-treated patients show significant improvement, with 11% of treated patients showing no residual psychosis. This review also describes the results of clozapine on aggressive and violent assault in a patient population characterized by severe functional deficits, typically chronic schizophrenia with severe impairment, chronic brain syndromes, and developmental handicap. Prior to the introduction of clozapine therapy, in a chronically disrupted milieu that precluded adequate psychosocial programming, seriously assaultive behaviour resulting in peer and staff injury was a common occurrence. Evidence suggests that clozapine is an effective medical treatment for the target symptoms of hostile agitation, threatening, and assaultive violence.

Quality of Life Outcomes of Supported Employment

This paper reports on the findings of a qualitative study of supported employment. The purpose of the study was to trace the process whereby people with a developmental handicap entered supported employment and became employed in regular jobs, and to consider the quality of life of those individuals. The quality of life of all participants was considerably enhanced as a result of the supported employment experience. The study also identified several problem areas and strategies for improving supported employment, particularly with respect to providing unobtrusive support in the workplace and facilitating social integration of the employee.