[Psychopharmacological treatment of mentally ill offenders : A sample survey of forensic psychiatric patients admitted to two forensic psychiatric facilities in Hesse].

Abstract

Background: Many studies on psychopharmacological treatments in general psychiatric care exist, but only few are addressing the psychopharmacological treatment of mentally ill offenders.

Study design: A sample survey was conducted at the Vitos Forensic Psychiatric Hospitals Gießen and Haina. Demographic, forensic, and pharmacological data were collected (nondigital patient files). All current inpatients were included. The primary objective of the study was a description of the pharmacological care of forensic patients.

Results: Data from 416 forensic psychiatric patients were analyzed. More than half of the patients (55.05%) obtained psychopharmacological polypharmacy (use of ≥ 2 psychotropic drugs), the majority of which resulted from antipsychotic polypharmacy (37.7%). The most commonly combined agents were two second generation antipsychotics. Among the antipsychotics, olanzapine was prescribed most frequently (17.8%) and used in most cases (19/34) at off-label dosages. Clozapine was combined most often (11.5%) with other psychotropic drugs.

Conclusion: The therapeutic advantage of combinations of psychotropic drugs compared to monotherapy is not sufficiently supported by clinical evidence. The therapeutic advantage of combination therapies compared with monotherapy is not sufficiently established for psychopharmacotherapy in general, and for antipsychotic treatment in particular. However, the high prevalence of psychopharmacological polypharmacy in this study reflects routine clinical practice in forensic psychiatry. Further analyses are meaningful to evaluate specific substance combinations in terms of drug safety and off-label use.