Is clozapine useful as a chemical cosh?

Probably.

From
http://priory.com/focus14.htm

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Effect Of Clozapine On Aggressive Behaviour

The improvement in aggressive behaviour among schizophrenic patients receiving clozapine has been an interesting finding in the clinical trials. (Maier et al- 1992, Wilson-1992, Volavka et al-1993, Chiles et al- 1994, Ebrahim et al-1994, Buckley- 1995Spivak B et al- 1997).
Question arises whether clozapine's efficacy derives from a specific antiaggressive effect or, the reduction in violent behaviour merely reflects an overall improvement in psychosis.
Buckley et al have addressed this issue by comparing the symptomatic response to clozapine in 30 institutionalized schizophrenic patients, 11 of whom displayed persistent violent behaviour before initial use of clozapine. Although the violent patients showed a dramatic reduction in aggression during 6 months of clozapine treatment, their overall response to measures on BPRS was comparable to that of nonviolent patients.
This suggests that violent behaviour was not tightly coupled to severity of illness per se and raises the possibility of a distinct antiaggressive effect.
Volavka et al-1993 in New York have also demonstrated a selective effect of clozapine on hostility that is above and beyond the improvement of psychosis.
It is presently uncertain how clozapine could be incorporated in the pharmacological treatment of aggression. Its side effects limit its broad use for patients of varying conditions and severity who also exhibit violent behaviour.
If the violence was a severe problem however, the benefit could outweigh the potential risk.
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