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Psychotropic prescribing in seriously violent men with schizophrenia or personality disorder in a UK high security hospital

  • Keir Stone-Brown (a1), Mahmood Naji (a2), Alex Francioni (a2), Kyle Myers (a2), Harsh Samarendra (a2), Haseeb Mushtaq-Chaudhry (a3), Stephen Heslop (a3), Samrat Sengupta (a3), Callum C. Ross (a3), Fintan Larkin (a3) and Mrigendra Das (a3)...

Abstract

Objectives

To analyze antipsychotic prescribing patterns in a UK high security hospital (HSH) that treats seriously violent men with either schizophrenia or personality disorder and examine how different groups consented to treatment and prescribing for metabolic conditions. We hypothesized that there would be high prevalence of antipsychotic polypharmacy, and high-dose antipsychotic and clozapine prescribing.

Background

HSHs treat seriously violent, mentally disordered offenders, and the extant literature on prescribing patterns in forensic settings is sparse.

Methods

Prescribing and clinical data on all 189 patients in a UK HSH were collected from the hospital’s databases. Data were analyzed using SPSS.

Results

The population was split into the following groups: schizophrenia spectrum disorder (SSD-only), personality disorder (PD-only), and comorbid schizophrenia spectrum disorder and PD. The majority (93.7%) of all patients were prescribed at least one antipsychotic, and (27.5%) were on clozapine. Polypharmacy was prevalent in 22.2% and high-dose antipsychotic in 27.5%. Patients on clozapine were more likely to be prescribed antidiabetic, statins, or antihypertensive medication. Patients in the PD-only group were more likely to be deemed to have the capacity to consent to treatment and be prescribed clozapine in contrast to the SSD-only group.

Conclusions

Rates of clozapine and high-dose antipsychotic prescribing were higher than in other psychiatric settings, while polypharmacy prescribing rates were lower. Higher clozapine prescribing rates may be a function of a treatment-resistant and aggressive population. A higher proportion of PD-only patients consented to treatment and received clozapine compared with in-house SSD-only as well as other psychiatric settings. Implications of the findings are discussed.

Copyright

Corresponding author

*Address for correspondence: Mrigendra Das, Broadmoor Hospital, Crowthorne, Berkshire, RG45 7EG, UK. (Email: mrigendra.das@wlmht.nhs.uk/mrigen.das@btinternet.com)

References

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