Prescribing Patterns of Psychotropic Drugs and Risk of Violent Behavior: A Prospective, Multicenter Study in Italy

Abstract

Background This prospective cohort study aimed at evaluating patterns of polypharmacy and aggressive and violent behavior during a 1-year follow-up in patients with severe mental disorders. Methods A total of 340 patients (125 inpatients from residential facilities and 215 outpatients) were evaluated at baseline with the Structured Clinical Interview for DSM-IV Axis I and II, Brief Psychiatric Rating Scale, Specific Levels of Functioning scale, Brown-Goodwin Lifetime History of Aggression, Buss-Durkee Hostility Inventory, Barratt Impulsiveness Scale, and State-Trait Anger Expression Inventory-2. Aggressive behavior was rated every 15 days with the Modified Overt Aggression Scale and treatment compliance with the Medication Adherence Rating Scale. Results The whole sample was prescribed mainly antipsychotics with high levels of polypharmacy. Clozapine prescription and higher compliance were associated with lower levels of aggressive and violent behavior. Patients with a history of violence who took clozapine were prescribed the highest number of drugs. The patterns of cumulative Modified Overt Aggression Scale mean scores of patients taking clozapine (n = 46), other antipsychotics (n = 257), and no antipsychotics (n = 37) were significantly different (P = .001). Patients taking clozapine showed a time trend at 1-year follow-up (24 evaluations) indicating a significantly lower level of aggressive behavior. Patient higher compliance was also associated with lower Modified Overt Aggression Scale ratings during the 1-year follow-up. Conclusion Both inpatients and outpatients showed high levels of polypharmacy. Clozapine prescription was associated with lower Modified Overt Aggression Scale ratings compared with any other antipsychotics or other psychotropic drugs. Higher compliance was associated with lower levels of aggressive and violent behavior.

Young age and the risk of violent behaviour in people with severe mental disorders: prospective, multicentre study

“… 36 Using a specific analytical methodology which made it possible to control the large number of MOAS ratings equal to 0, a linear increase in MOAS ratings was observed, especially in participants with a history of violence, who exhibited more aggressive and violent behaviour than those with no history of violence. 52 …”

Positive and negative syndrome scale in forensic patients with schizophrenia spectrum disorders: a systematic review and meta-analysis

“…Being in a forensic facility implies that patients had guaranteed pharmacological treatment, which promotes clinical stabilization, symptoms reduction, and a better course of the disorder. Moreover, some studies have shown that ensuring treatment compliance decreases the risk of violence [ 66 – 68 ].…”

“…Being in a forensic facility implies that patients had guaranteed pharmacological treatment, which promotes clinical stabilization, symptoms reduction, and a better course of the disorder. Moreover, some studies have shown that ensuring treatment compliance decreases the risk of violence [66][67][68]. Nevertheless, many clinical characteristics of patients included in our meta-analysis were unspecified, and this makes it difficult to draw precise conclusions.…”

Pharmacological interventions to reduce violence in patients with schizophrenia in forensic psychiatry

“…Nevertheless, this finding is in agreement with studies among non-forensic psychiatric inpatients reporting a reduction of aggressive behavior among patients treated with clozapine. 14,[29][30][31][32] The effects of risperidone were studied in two studies. Gibbon et al 21 retrospectively investigating the clinical charts of 118 patients for the effects of RLAI and found that 25% experienced a reduction in violent incidents, but this study did not use a control group.…”