High-dose antipsychotic medication in maximum security

Tavernor, Ros; Swinton, Mark; Tavernor, S.J.

doi:10.1080/095851800362346

Cited by 7 publications

(22 citation statements)

References 2 publications

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“…Outcomes comparing patient groups on high (n = 32) versus low (n = 32) doses of Chlorpromazine (Tavernor, Swinton, & Tavernor, 2000), reported most marked and negative SMD differences in the high dose group on thinking disturbance (SMD = 0.95) irritability (SMD = 0.88) and reported incidents of aggression over the past month (SMD = 0.63). High and low dosage groups were matched on demographics; however, as symptom and function baseline characteristics were not recorded, concluding outcomes on the basis of high versus low dosage is uncertain.…”

Section: Pharmacological Interventionsmentioning

confidence: 99%

A Critical Analysis of Clinical Evidence from High Secure Forensic Inpatient Services

Tapp

Perkins

Warren

et al. 2013

International Journal of Forensic Mental Health

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High secure forensic inpatient hospitals serve important functions in the detention and rehabilitation of people with serious mental health needs who present as a risk to society.Establishing whether services are effective in restoring mental health and reducing risk is an important task, but one that has not been systematically undertaken. A systematic review of outcome evidence from this setting was therefore conducted to establish its scope and quality.Evidence was found from twenty-two studies for nine different interventions targeting multiple and overlapping outcomes, which included recidivism, mental health, aggression, social functioning and quality of life. Studies were commonly assessed as being at a potentially high risk of bias from validity threats. The 'best' available evidence was for medication, psychoeducation and third-wave cognitive-behavioural interventions. Clinical implications are tentatively offered given the narrow focus of the review on high security. Directions for the high secure services research agenda are more definitively proposed.

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Section: Pharmacological Interventionsmentioning

confidence: 99%

A Critical Analysis of Clinical Evidence from High Secure Forensic Inpatient Services

Tapp

Perkins

Warren

et al. 2013

International Journal of Forensic Mental Health

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“…There is, however, no evidence suggesting that high dosage in general is preferable (8,17). In contrast, there are more side-effects such as akathisia, thought to be one of the causes of aggressive behaviour (18).…”

Section: Discussionmentioning

confidence: 91%

“…Another study found in a maximumsecurity hospital in England that patients with high antipsychotic dosage had more psychiatric comorbidity and side-effects than patients with standard dosage. It was concluded that there was little benefit from the use of high-dose antipsychotics (8). Regarding antipsychotic polypharmacy, a study performed in Australia found that 22% of patients in a forensic hospital received antipsychotic polypharmacy (9).…”

mentioning

confidence: 99%

Antipsychotic medication and length of stay at a psychiatric maximum-security unit in Norway (1987–2000)

Renkel

Rasmussen

2006

Nordic Journal of Psychiatry

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The aim of this study was to evaluate psychopharmacological treatment and the length of stay (LOS) of patients with schizophrenia in a maximum-security psychiatric unit. Data were collected from the hospital files of 82 consecutively admitted patients with schizophrenia who were both admitted and discharged between the years 1987 and 2000. Psychotropic medication and LOS at the time of discharge were registered. Ninety-five per cent of the patients received antipsychotic medication. Zuclopenthixol was the most frequent medication, given to 43% of the patients. Antipsychotic polypharmacy was found in 20% of the cases. Twenty-seven per cent of the patients were medicated with doses above the recommended therapeutic dose range. During the study period, there was no change in the administration and number of psychotropics, but there was an increase in the dosage of antipsychotics. However, LOS was unchanged during the same time. This supports other findings, which suggest that there is no clinical benefit of higher antipsychotic dosage. It is suggested that an optimized medication practice could yield beneficiary effects, not only for schizophrenic symptoms, but also for violence in schizophrenic patients.

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“…The primary reasons for exclusion of studies were that the studied populations were not treated within a forensic setting or the studies did not evaluate the effect of an intervention (list of excluded full-text studies with reasons for exclusion are available on request). All 10 included studies (22)(23)(24)(25)(26)(27)(28)(29)(30)(31) were assessed as having a high risk of bias, primarily due to selection bias. The review process and number of reviewed articles are summarized in the flow diagram in Figure 1.…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

“…The 10 included studies, which are further described in Table 1, were conducted in the United Kingdom (24,25,30,31), USA (23,29), and Canada (22,(26)(27)(28). Seven of the studies were retrospective.…”

Section: Synthesized Findingsmentioning

confidence: 99%

Pharmacological Treatment in Forensic Psychiatry—A Systematic Review

et al. 2020

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Background: Pharmacological treatment is of great importance in forensic psychiatry, and the vast majority of patients are treated with antipsychotic agents. There are several systematic differences between general and forensic psychiatric patients, e.g. severe violent behavior, the amount of comorbidity, such as personality disorders and/or substance abuse. Based on that, it is reasonable to suspect that effects of pharmacological treatments also may differ. The objective of this systematic review was to investigate the effects of pharmacological interventions for patients within forensic psychiatry. Methods: The systematic review protocol was pre-registered in PROSPERO (CRD42017075308). Six databases were used for literature search on January 11, 2018. Controlled trials from forensic psychiatric care reporting on the effects of antipsychotic agents, mood stabilizers, benzodiazepines, antidepressants, as well as pharmacological agents used for the treatment of addiction or ADHD, were included. Two authors independently reviewed the studies, evaluated risk of bias and assessed certainty of evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results: The literature search resulted in 1783 records (titles and abstracts) out of which 10 studies were included. Most of the studies included were retrospective and nonrandomized. Five of them focused on treatment with clozapine and the remaining five on other antipsychotics or mood stabilizers. Five studies with a high risk of bias indicated positive effects of clozapine on time from treatment start to discharge, crime-free time, time from discharge to readmission, improved clinical functioning, and reduction in aggressive behavior. Psychotic symptoms after treatment were more pronounced in

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High-dose antipsychotic medication in maximum security

Cited by 7 publications

References 2 publications

A Critical Analysis of Clinical Evidence from High Secure Forensic Inpatient Services

A Critical Analysis of Clinical Evidence from High Secure Forensic Inpatient Services

Antipsychotic medication and length of stay at a psychiatric maximum-security unit in Norway (1987–2000)

Pharmacological Treatment in Forensic Psychiatry—A Systematic Review

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