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    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.

    Citrome, Leslie and Volavka, Jan 2015. Preventing Violence in Patients with Schizophrenia. Current Treatment Options in Psychiatry, Vol. 2, Issue. 2, p. 182.

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    Volavka, J. Van Dorn, R.A. Citrome, L. Kahn, R.S. Fleischhacker, W.W. and Czobor, P. 2016. Hostility in schizophrenia: An integrated analysis of the combined Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) and the European First Episode Schizophrenia Trial (EUFEST) studies. European Psychiatry, Vol. 31, p. 13.

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    Citrome, Leslie Du, Yangchun Risinger, Robert Stankovic, Srdjan Claxton, Amy Zummo, Jacqueline Bose, Anjana Silverman, Bernard L. and Ehrich, Elliot W. 2016. Effect of aripiprazole lauroxil on agitation and hostility in patients with schizophrenia. International Clinical Psychopharmacology, Vol. 31, Issue. 2, p. 69.

    Garriga, Marina Pacchiarotti, Isabella Kasper, Siegfried Zeller, Scott L. Allen, Michael H. Vázquez, Gustavo Baldaçara, Leonardo San, Luis McAllister-Williams, R. Hamish Fountoulakis, Konstantinos N. Courtet, Philippe Naber, Dieter Chan, Esther W. Fagiolini, Andrea Möller, Hans Jürgen Grunze, Heinz Llorca, Pierre Michel Jaffe, Richard L. Yatham, Lakshmi N. Hidalgo-Mazzei, Diego Passamar, Marc Messer, Thomas Bernardo, Miquel and Vieta, Eduard 2016. Assessment and management of agitation in psychiatry: Expert consensus. The World Journal of Biological Psychiatry, Vol. 17, Issue. 2, p. 86.


The psychopharmacology of violence: making sensible decisions

  • Leslie Citrome (a1) and Jan Volavka (a2)
  • DOI:
  • Published online: 26 February 2014

Violent behavior associated with mental disorders is a common reason for admission to a psychiatric inpatient unit. Once hospitalized, patients may continue to be intermittently agitated and have persistent aggressive behaviors, preventing their discharge back into the community. Managing agitation quickly with effective pharmacological agents can avoid further escalation to aggression and violence. In the acute setting, this usually involves the parenteral use of antipsychotics, with or without benzodiazepines. Within the past decade, short-acting intramuscular formulations of second-generation antipsychotics have become available and provide a means to induce calm with a substantially lower risk of acute dystonia or akathisia compared with haloperidol. New alternative formulations that avoid injections include inhalation and sublingual administration. Longer-term management of persistent aggressive behavior by reducing the frequency and intensity of future episodes of agitation is more complex. In contrast to agitation associated with schizophrenia or bipolar mania, no agents have yet been approved by regulatory agencies for the treatment of persistent aggressive behavior. The strongest evidence supports the use of clozapine as an antihostility agent, followed by olanzapine. Adjunctive strategies with anticonvulsants and beta-adrenergic agents may also be worthwhile to consider.

Corresponding author
*Address for correspondence: Leslie Citrome, MD, MPH, 11 Medical Park Drive, Suite 106, Pomona, NY 10970, USA. (Email:
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