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Newer Antipsychotics No Better Than Older Medications in Reducing Schizophrenia-related Violence

Science Update

Antipsychotic medications can reduce the risk of violence among people with schizophrenia, but the newer atypical antipsychotics are no more effective in doing so than older medications, according to a recent analysis of data from the NIMH-funded Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE). The study was published July 1, 2008, in the British Journal of Psychiatry.

CATIE compared the newer atypical medications quetiapine (Seroquel), olanzapine (Zyprexa), risperidone (Risperdal) and ziprasidone (Geodon) with the older antipsychotic perphenazine. Previously reported results showed that perphenazine was no less effective in treating schizophrenia symptoms than the newer atypicals. This new analysis examined whether any of the medications specifically reduced the frequency of violence, a rare symptom associated with the disorder.

Jeffrey Swanson, Ph.D., and Marvin Swartz, M.D., of Duke University and colleagues examined data from the 1,445 CATIE participants for which baseline information on violent behavior was available. They found that among the 653 participants who completed six months of treatment on their initially assigned medication, the frequency of violent acts declined from 16 percent to 9 percent overall. None of the atypical medications outperformed perphenazine, and quetiapine specifically appeared to be less effective than perphenazine.

Those who took their medication as directed were less likely to be violent, except for those who had a history of childhood conduct problems. Moreover, those who lived with others, had substance use problems, had been victimized in the past, and were of lower economic status were more likely to have problems with violent behavior, regardless of medication usage.

The researchers conclude that, contrary to some previous studies, the atypical antipsychotics have no advantage over the older medication in reducing violence. In addition, violence associated with circumstances unrelated to the disorder, such as a history of conduct problems, likely will not be treated effectively with antipsychotics alone. Rather, more intensive psychosocial or family-based supportive therapy may be needed to reduce violent behavior in people with these other risk factors.

Reference

Swanson JW, Swartz MS, Van Dorn RA, Volavka J, Monahan J, Stroup TS, McEnvoy JP, Wagner HR, Elbogen EB, Lieberman JA for the CATIE investigators. Comparing antipsychotic medication effects on reducing violence in persons with schizophrenia. British Journal of Psychiatry. 2008 Jul; 193: 37-43.