Kimmo Herttua, Mike Crawford, Tapio Paljarvi, Seena Fazel
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引用次数: 3
Abstract
Background: Despite uncertain benefits, people with personality disorder are commonly treated with antipsychotic medication.
Objective: To investigate the association between antipsychotics and violent crimes and suicidal behaviour in individuals with personality disorder.
Methods: We used nationwide Danish registries to identify all individuals with diagnosed personality disorder aged 18-64 years during 2007 to 2016. Antipsychotics were recorded in dispensed prescriptions, and individuals were followed up for police-recorded suspicions for violent crimes and healthcare presentations of suicidal behaviour. We applied a within-individual design where outcome rates for individuals with personality disorder during medicated periods were compared with rates during non-medicated periods.
Findings: The cohort included 166 328 people with diagnosed personality disorder, of whom 79 253 were prescribed antipsychotics, presented at least one outcome and were thus included in the within-individual analyses. Compared with periods when individuals were not on antipsychotic medication, violent crime suspicions were 40% lower (incident rate ratio (IRR) 0.60, 95% CI 0.55 to 0.63) in men and 10% lower (IRR 0.90, 95% CI 0.79 to 1.01) in women, while rates of suicidal behaviour were 32% lower both in men (IRR 0.68, 95% CI 0.66 to 0.71) and in women (IRR 0.68, 95% CI 0.65 to 0.70). In subgroup analyses, the magnitude of the association varied across specific personality disorders for criminal outcomes but less for suicidal behaviour, with largest association in dissocial personality disorder for violent criminality (IRR 0.53, 95% CI 0.47 to 0.59).
Conclusions: Treatment with antipsychotics was associated with reduced risks for violent crime suspicions and suicidal behaviour among individuals with personality disorder.
Clinical implications: Potential effects of antipsychotics on suicidal behaviour and violence should be taken into account when considering treatment options for people with personality disorders.
背景:尽管疗效不确定，但人格障碍患者通常使用抗精神病药物治疗。目的:探讨抗精神病药物与人格障碍患者暴力犯罪和自杀行为的关系。方法:我们使用丹麦全国登记系统来识别2007年至2016年期间年龄在18-64岁之间被诊断为人格障碍的所有个体。在处方中记录了抗精神病药物，并对警方记录的暴力犯罪嫌疑人和医疗保健中出现的自杀行为进行了跟踪调查。我们采用了个体内设计，将人格障碍患者在服药期间的转归率与非服药期间的转归率进行比较。研究结果:该队列包括166328名诊断为人格障碍的人，其中79253人服用抗精神病药物，表现出至少一种结果，因此被纳入个体内分析。与不服用抗精神病药物的个体相比，男性的暴力犯罪嫌疑降低了40%(发生率比(IRR) 0.60, 95% CI 0.55至0.63)，女性的暴力犯罪嫌疑降低了10% (IRR 0.90, 95% CI 0.79至1.01)，而男性(IRR 0.68, 95% CI 0.66至0.71)和女性(IRR 0.68, 95% CI 0.65至0.70)的自杀行为发生率均降低了32% (IRR 0.68, 95% CI 0.65至0.70)。在亚组分析中，特定人格障碍与犯罪结果的关联程度各不相同，但与自杀行为的关联较小，与暴力犯罪的反社会人格障碍的关联最大(IRR 0.53, 95% CI 0.47至0.59)。结论:抗精神病药物治疗与人格障碍患者暴力犯罪嫌疑和自杀行为风险降低有关。临床意义:在考虑人格障碍患者的治疗方案时，应考虑到抗精神病药物对自杀行为和暴力的潜在影响。
期刊介绍：
Evidence-Based Mental Health alerts clinicians to important advances in treatment, diagnosis, aetiology, prognosis, continuing education, economic evaluation and qualitative research in mental health. Published by the British Psychological Society, the Royal College of Psychiatrists and the BMJ Publishing Group the journal surveys a wide range of international medical journals applying strict criteria for the quality and validity of research. Clinicians assess the relevance of the best studies and the key details of these essential studies are presented in a succinct, informative abstract with an expert commentary on its clinical application.Evidence-Based Mental Health is a multidisciplinary, quarterly publication.
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