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

Background There is an increased risk of violence among people with schizophrenia, and this may become serious as evidenced by the small number of people who have been admitted to a special (high security) hospital. Such people have usually been treated extensively elsewhere without success. Method A naturalistic study was carried out of 50 special hospital patients started on clozapine and followed up for two years, using a modified HONOS to their clinical record. Results Nearly one quarter were unable to sustain clozapine for more than 12 months, for a variety of reasons. As a group they showed significantly less symptom reduction than those who continued. For those on clozapine for a minimum of 12 months continuously, the majority showed symptom reduction. Of the 20 patients who were still violent in the special hospital prior to the trial, symptom reduction was associated with reduction in violence. The rate of discharge for patients who started clozapine but were unable or unwilling to continue it was very low. In contrast, the rate of discharge for patients started on clozapine who continued treatment for at least one year was elevated to a rate similar to that of patients not treated with clozapine. Conclusions The results tend to confirm other work which suggests that for people with schizophrenia violence is commonly symptom dependent. They show that a trial of clozapine in such patients is well worth while, as the majority can tolerate it and the majority of those are improved