Clozapine treatment of long‐standing schizophrenia and serious violence: a two‐year follow‐up study of the first 50 patients treated with clozapine in Rampton high security hospital

Dalal, Brian; Larkin, Emmet; Leese, Morven; Taylor, Pamela J.

doi:10.1002/cbm.304

Cited by 20 publications

(19 citation statements)

References 9 publications

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“…Certain positive experiences corresponded to the clinical evidence for specific interventions, for example, the value of medication (specifically Clozapine) in managing symptoms or the benefits reported from talking therapies (Dalal, Larkin, Leese, & Taylor, 1999). Accounts of experiences also provide original insights into elements of care, which can be substantiated by a degree of theoretical coherence.…”

Section: Discussionmentioning

confidence: 85%

What do the experts by experience tell us about ‘what works’ in high secure forensic inpatient hospital services?

Tapp

Warren

Fife‐Schaw

et al. 2013

The Journal of Forensic Psychiatry & Psychology

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The evidence base for 'what works' for patients detained in high secure hospitals has predominantly been established from a clinical perspective, with the voices of those at the centre of care, the expert by experience, absent. Neglecting this voice renders an important source of information for evidence-based practice inaccessible to outcome evaluators. Twelve high secure patients considered 'ready' to be discharged were interviewed to explore what in their view had helped or hindered their progress to this stage. Thematic analysis steps were applied to interviews and eight themes were generated that represented valued elements of high security: temporary suspension of responsibility, collaboration in care, learning from others, supportive alliances, specific interventions (medical and psy-chotherapeutic), a safe environment and opportunities for work. Narratives demonstrated the complementary and unique contribution of the patient experience in informing 'what works', and are discussed alongside existing theories relevant to promoting clinical change and risk reduction.

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Section: Discussionmentioning

confidence: 85%

What do the experts by experience tell us about ‘what works’ in high secure forensic inpatient hospital services?

Tapp

Warren

Fife‐Schaw

et al. 2013

The Journal of Forensic Psychiatry & Psychology

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“…There is evidence for pharmacological interventions, with reports of benefits from the use of Clozapine with patients who have treatment resistant schizophrenia (Dalal et al, 1999;Swinton & Haddock, 2000;Tiihonen et al, 2003); findings that are congruent with existing UK practice guidance (National Institute for Clinical Excellence, 2009). Preliminary evidence for psychoeducation for those with mental illness (including schizophrenia) indicates improvements in insight and therapy engagement, emphasizing the interaction effects of interventions in the high secure setting (Aho-Mustonen et al, 2008).…”

Section: Discussionmentioning

confidence: 86%

“…Two studies (Dalal, Larkin, Leese, & Taylor, 1999;Swinton & Haddock, 2000) investigating the efficacy of Clozapine compared to a non-Clozapine group reported modest improvements in discharge rates at two years respectively (SMD = 0.58; RR = 2.45). A further follow up at 4 years was reported for the former study (RR = 1.96) in addition to positive reductions in violent behaviour (RR = 1.24).…”

Section: Pharmacological Interventionsmentioning

confidence: 99%

A Critical Analysis of Clinical Evidence from High Secure Forensic Inpatient Services

Tapp

Perkins

Warren

et al. 2013

International Journal of Forensic Mental Health

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High secure forensic inpatient hospitals serve important functions in the detention and rehabilitation of people with serious mental health needs who present as a risk to society.Establishing whether services are effective in restoring mental health and reducing risk is an important task, but one that has not been systematically undertaken. A systematic review of outcome evidence from this setting was therefore conducted to establish its scope and quality.Evidence was found from twenty-two studies for nine different interventions targeting multiple and overlapping outcomes, which included recidivism, mental health, aggression, social functioning and quality of life. Studies were commonly assessed as being at a potentially high risk of bias from validity threats. The 'best' available evidence was for medication, psychoeducation and third-wave cognitive-behavioural interventions. Clinical implications are tentatively offered given the narrow focus of the review on high security. Directions for the high secure services research agenda are more definitively proposed.

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“…In Chiles et al, 87 for example, all the improvement apparently occurred between weeks 2 and 4 of treatment. In Dalal et al 94 the reduction in violence occurred only in the early phase. One might tentatively conclude that, while the anti-aggressive benefit may not emerge immediately, an empirical trial of perhaps one month should be sufficient to gauge the likelihood of response to an antipsychotic medication.…”

Section: Discussionmentioning

confidence: 96%

“…Bitter et al, The investigation reportedly began with 7655 subjects, of whom 5018 received monotherapy, of whom 3135 completed. This report seems to be a post hoc analysis of a prospective study, but the method, as reported, is ambiguous Buckley, et al, 1995 andDalal et al, 1999. are also reported inTable 3because subsets of patients were preselected as violent.Although Chiles et al, 1994 is a retrospective study, data were only reported for the subset that had completed 12 weeks of tx, so that the completion rate is only 82.7%.Re.Swanson et al, 2004b: This paper included data on 124 completers but fails to report how many of the 403. patients were on one of the two study drugs at the start of the study period.Re Wilson, 1992…”

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confidence: 79%

Pharmacological Management of Persistent Hostility and Aggression in Persons With Schizophrenia Spectrum Disorders: A Systematic Review

Victoroff

Coburn

Reeve

et al. 2014

JNP

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The incidence of aggressive behaviors is higher among persons with schizophrenia spectrum disorders (SSDs) than among persons without such disorders. This phenomenon represents a risk to the well-being of patients, their families, and society. The authors undertook a systematic review of the English language literature to determine the efficacy of neuropharmacological agents for the management of hostility and aggression among persons with SSDs. The search combined findings from the Medline, EMBASE, and PsycINFO databases. Ninety-two full text articles were identified that reported relevant findings. The American Academy of Neurology criteria were used to determine levels of evidence. Paliperidone-extended release is probably effective for the management of hostility among inpatients with SSDs who have not been preselected for aggression (Level B). Clozapine is possibly more effective than haloperidol for the management of overt aggression and possibly more effective than chlorpromazine for the management of hostility among inpatients with SSDs who have not been preselected for aggression (Level C). Clozapine is also possibly more effective than olanzapine or haloperidol for reducing aggression among selected physically assaultive inpatients (Level C). Adjunctive propranolol, valproic acid, and famotidine are possibly effective for reducing some aspects of hostility or aggression among inpatients with SSDs (Level C). Paliperidone-extended release currently appears to be the agent for the management of hostility among inpatients with SSDs for which there is the strongest evidence of efficacy.

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Clozapine treatment of long‐standing schizophrenia and serious violence: a two‐year follow‐up study of the first 50 patients treated with clozapine in Rampton high security hospital

Abstract: ABSTRACT

Cited by 20 publications

References 9 publications

What do the experts by experience tell us about ‘what works’ in high secure forensic inpatient hospital services?

What do the experts by experience tell us about ‘what works’ in high secure forensic inpatient hospital services?

A Critical Analysis of Clinical Evidence from High Secure Forensic Inpatient Services

Pharmacological Management of Persistent Hostility and Aggression in Persons With Schizophrenia Spectrum Disorders: A Systematic Review

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