Psychopharmaka – Anwendungspraxis in Maßregelvollzug und Allgemeinpsychiatrie im Vergleich

Abstract

ZusammenfassungDie psychopharmakologische Anwendungspraxis in Maßregelvollzug und Allgemeinpsychiatrie sollte vergleichend untersucht werden.Die Medikamentenstichtagserhebungen 2014–2019 der Pharmakoepidemiologie und -Vigilanz (Pharmako-EpiVig) des Bayerischen Institut für Daten, Analysen und Qualitätssicherung (BIDAQ) aus Maßregelvollzug (n = 4590) und Allgemeinpsychiatrie (n = 5136) des Isar-Amper-Klinikums München Ost wurden ausgewertet.Mittleres Alter und Diagnoseverteilung der Patientenklientele unterschieden sich, ferner Substanzauswahl und Dosierung, die im Maßregelvollzug nahezu durchweg höher lag. Bei schizophren erkrankten forensischen Patienten wurde am häufigsten Clozapin gegeben. In beiden Fachbereichen fiel die häufige Anwendung von Valproat auf.Die Ergebnisse könnten als Hinweis gewertet werden, dass forensische Patienten schwerere und therapierefraktärere Erkrankungen aufweisen, und dass in der klinischen Praxis insgesamt eine symptombezogene antiaggressive Behandlung bedeutsam scheint.

Gender Differences in the Psychopharmacological Treatment of Forensic In-Patients With Schizophrenia

“…Earlier onset of schizophrenia usually means a more severe course of illness with long-lasting symptoms being relatively non-responsive to antipsychotic medication (16), which might provide an explanation as to why women showed worse psychopathology than men in this study. Since the treatment goal in forensic psychiatry pertains to the prevention of future delinquency through remission of psychopathology (7), a future research project could examine the influence of gender differences in the remission of psychopathological symptoms on delinquent recidivism. Moreover, women did not only show a worse response rate for single positive and negative symptoms, but also seemed to experience more pronounced feelings of guilt, anxiety, somatic discomfort, and depression, as well as less cognitive flexibility compared to men, indicating that female forensic patients with schizophrenia need more comprehensive treatment strategies and goals beyond the reduction of negative and positive symptoms.…”

“…This makes it difficult to generalize and transfer the results to other institutions and regions, as the results could to some extent reflect local or clinic-specific treatment strategies. On the other hand, this unity of place can be seen as a methodological advantage in that it enabled homogeneous data collection and largely excluded other influencing factors such as regional or national differences in application practices (7).…”

“…Evidence regarding psychopharmacological treatment strategies for schizophrenia in forensic settings is rare, focusing mainly on differences between general psychiatric and forensic samples (6,7). Vasic et al (8) not only examined the prescribed medication, but also the respective psychopathological status as well as neurological and metabolic side effects of inpatients with schizophrenia in either forensic (n = 29) or general psychiatry (n = 31) in two southern German clinics.…”