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Antipsychotic Overdosing and Polypharmacy in Schizophrenic Delinquents Explored
M P Günther1, J Kirchebner1, S Kling2
1University Hospital of Psychiatry Zurich, Switzerland.
International Journal of Offender Therapy and Comparative Criminology
|December 31, 2019
Summary
Antipsychotic medication management in schizophrenic offenders is complex. Factors like personality disorders, emotional withdrawal, and rapport influence overdosing, while complaints and IQ impact polypharmacy, highlighting the need for personalized treatment strategies.
Area of Science:
- Forensic Psychiatry
- Psychopharmacology
- Clinical Psychology
Background:
- Schizophrenia in forensic populations presents unique treatment challenges.
- Antipsychotic medication management, including overdosing and polypharmacy, requires careful consideration in offenders.
- Understanding factors associated with medication deviations is crucial for patient safety and treatment efficacy.
Purpose of the Study:
- To identify predictors of antipsychotic overdosing and polypharmacy in individuals with schizophrenia admitted to a Swiss forensic hospital.
- To analyze the relationship between specific clinical, demographic, and legal factors and medication management deviations.
Main Methods:
- A logistic regression model was applied to data from 289 schizophrenic offenders treated between 1995 and 2016.
- Admission data including personality disorders, emotional withdrawal, motor retardation, rapport, complaints about physicians, IQ, security level, attention, previous convictions, rule-breaking, compulsory measures, legal prognosis, grandiosity, social withdrawal, and depressive symptoms were analyzed.
Main Results:
- Antipsychotic overdosing was associated with the absence of a personality disorder, increased emotional withdrawal, and motor retardation, while poor rapport was protective.
- Polypharmacy was linked to complaints about physicians, higher IQ, reduced ward security, and poor attention. Conversely, previous convictions, rule-breaking, compulsory measures, poor legal prognosis, grandiosity, passive social withdrawal, and depressive symptoms were associated with decreased polypharmacy.
Conclusions:
- Clinical and legal factors significantly influence antipsychotic overdosing and polypharmacy in schizophrenic offenders.
- Treatment strategies should be individualized, considering patient-specific characteristics and contextual factors within the forensic setting.
- Further research is warranted to optimize medication management and improve outcomes for this vulnerable population.
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