Prevalence and Appropriateness of Antipsychotic Prescribing in an Italian Prison

Pelizza, Lorenzo; Maestri, Davide; Paulillo, Giuseppina; Pellegrini, Pietro

doi:10.1097/jcp.0000000000001495

Cited by 10 publications

(14 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…According to the National Health and Nutrition Examination Survey (USA), the prevalence of the antipsychotic use in the USA is estimated at roughly 1.7% (Dennis et al , 2020). The prevalence of antipsychotic use in prisons, according to previous surveys varies from 3.7%–14.10% (Hassan et al , 2014; Hervás et al , 2019; Pelizza et al , 2022). In our study, the prevalence of inmates prescribed an antipsychotic is 7.58, but nearly fivefold higher compared with general population.…”

Section: Resultsmentioning

confidence: 99%

Analysis of antipsychotic drugs prescribing in incarcerated persons in a Serbian correctional facility

Čekerinac,

Starčević,

Basailović

et al. 2023

IJOPH

View full text Add to dashboard Cite

Purpose Prison settings have limited resources, and it is of particular interest to analyze which antipsychotics are commonly prescribed in these conditions and to determine the prevalence of the adverse effects. Design/methodology/approach A cross-sectional, epidemiological survey was used to measure the prevalence of antipsychotic prescribing among adult prisoners in Sremska Mitrovica Prison in 2020. Findings The prevalence of antipsychotic use was 7.58%. The most commonly prescribed antipsychotic was clozapine (45.36%), but also olanzapine, haloperidol and risperidone were prescribed. The incidence of extrapyramidal adverse effects was nonexistent and the metabolic parameters did not differ between participants using metabolic syndrome–inducing antipsychotics and those who were prescribed metabolically inert medications. The prescribed doses were lower compared with the recommended. Research limitations/implications This research includes certain points that should be cautiously considered. First, the data were cross-sectional and the findings did not provide causal interpretations. Second, the data are from a single penitentiary institution, albeit the largest in the country; however, that may affect the generalizability of the findings. Third, because the included subjects were not hospitalized, some laboratory analyses were not available, according to the local regulations, and thus the prevalence of metabolic syndrome could not be precisely determined. Practical implications The prevalence of the antipsychotic use in prison environment is significantly higher than in general population. The most frequently prescribed antipsychotics are clozapine and olanzapine. The prevalence of adverse effects is rare, however, that is possibly due to low doses of the prescribed antipsychotics. The list of therapeutic options available to the incarcerated persons in this facility is also limited. The list of available antipsychotics does not include some atypical antipsychotics with more favorable safety and tolerability profile, such as aripiprazole or cariprazine. Long-acting antipsychotic injectables were also not available to these patients. Laboratory analyses are not regularly conducted and do not include some essential parameters such as lipid status or differential blood count. Low-dose antipsychotics for behavioral symptoms appears to be well tolerated under prison conditions where adherence is assured. It is effective during the prison stay but long-term effects, especially after release from prison, had not been studied. Social implications This paper advocates for better quality of health care in this correctional facility: more therapeutic options and better laboratory monitoring. The authors justify the use of clozapine in this settings due its benefits in reducing violence and aggression; however, further research would be necessary to clarify does the use of clozapine in incarcerated persons cause behavioral improvements that could result in shorter incarcerations, less recidivism and better quality of life. Originality/value To the best of the authors’ knowledge, this is the first insight of the antipsychotic prescribing practice in Serbia. There is very limited data on prisoners’ health care, especially mental health care, in Balkan countries. The antipsychotic prescribing pattern in this sample is characterized with higher than expected clozapine use, but without expected adverse effects.

show abstract

Section: Resultsmentioning

confidence: 99%

Analysis of antipsychotic drugs prescribing in incarcerated persons in a Serbian correctional facility

Čekerinac,

Starčević,

Basailović

et al. 2023

IJOPH

View full text Add to dashboard Cite

show abstract

“…Balancing the goal of offering adequate health care with the need to prevent disruptive behaviors can create conflicts of interest for medical professionals. Given inconsistent findings in prisons, adherence to guidelines and implementation of periodic monitoring due to the risk of adverse effects is considered crucial ( 58 ). Although benzodiazepines should not be used as a long-term treatment due to their side effects including cognitive impairment and dependence, prison populations frequently receive this medication with the intention of bridging the onset of action of antidepressants and antipsychotics ( 57 ).…”

Section: Discussionmentioning

confidence: 99%

Psychiatric and legal considerations for ketamine treatment within prison settings

Bayrhammer-Savel,

Ortner,

Van Hout

et al. 2024

Front. Psychiatry

View full text Add to dashboard Cite

The fundamental right to equivalence of health care in prison settings encompasses the provision of medication to address mental health conditions. Considering the increased risk for self-harm among individuals dealing with depression, the limited effectiveness of conservative antidepressants is a major challenge in psychiatry. The high prevalence of suicidal tendencies within prison populations underscores the imperative for state-of-the-art pharmacological treatment to uphold adequate health care standards. Notably, the denial of access to effective medication could be deemed a violation of human rights of people living in prison according to international treaties, domestic law, and United Nations normative standards of detention. This article presents the authors’ perspective on the accessibility of ketamine treatment in prison settings, discussing psychiatric and legal considerations as well as current challenges in this context. Implementing novel psychopharmacological interventions may alleviate the distress experienced by individuals struggling with depressive symptoms and suicidality. At the same time, unprecedented treatment alternatives bring along potential issues, including limited understanding of long-term effects and the risk of abuse. Given the scarce data-availability, a pressing need exists for further research on the benefits and risks of ketamine treatment within prison populations.

show abstract

“…For this preventive purpose, we decided to administer the JSAT routinely to all newly received prisoners within a systematic screening procedure also including a direct psychological interview. After retention in care by our multi‐professional mental healthcare team, prisoners with mental disorder or substance use disorder were provided with interventions informed by the assessment, including integrated (multidisciplinary) treatment, individual psychological treatment and/or individual psychiatric treatment (in case of pharmacological needs) (Pelizza, Maestri, Paulillo, et al., 2022).…”

Section: Discussionmentioning

confidence: 99%

Psychological screening service for men newly admitted to an Italian prison: Preliminary clinical outcome analysis after 1 year of clinical activity

Pelizza,

Rossi,

Zambelli

et al. 2023

Criminal Behav Ment Health

View full text Add to dashboard Cite

BackgroundScreening for mental disorders among prisoners is crucial for early detection and intervention of psychopathology and substance use disorders. In Italy, only a minority of prisons have implemented a structured screening process, and there is not yet a standard approach to this worldwide.AimsFirst, to describe a systematic psychological screening for early identification of mental disorder, including drug use disorders, and suicide risk among men on reception into one Italian prison, designed to inform management and, secondly, to describe mental health outcomes among those prisoners accepted into the in‐reach mental health service as a result of the assessment.MethodsAll prisoners newly received in the Parma Penitentiary Institute at any time in 2020 were screened using the Jail Screening Assessment Tool. Those who screened positive for any mental disorder, including substance use disorders and suicide indicators, were asked to complete the Parma Scale for the treatment evaluation of offenders with psychiatric disorders (Pr‐Scale), a locally developed tool that allows for the measurement of mental state change as well as changes in treatment and management. Scores on this scale soon after reception were compared with scores after 1 year of work with the in‐reach team.ResultsAmong 303 newly admitted male prisoners in 2020, 167 (55%) screened positive for substance use disorder and 30 (10%) for other primary mental disorders. Most of these (n = 151) were offered and accepted care by the mental health in‐reach service. After 1 year, those who had been treated by this service showed significant improvement in all Pr‐Scale clinical variables.ConclusionsOur findings support the extension of a psychological screening into a service for new receptions to Italian prisons. They add evidence for the utility of the Pr‐Scale for detecting those newly admitted prisoners likely to benefit from early mental health interventions provided by in‐reach services and for evidencing resultant change. Future studies are needed to replicate our results in other Italian prisons as a precursor to systems improvement, while other countries might also benefit from using similar evaluation and reevaluation routinely.

show abstract

Prevalence and Appropriateness of Antipsychotic Prescribing in an Italian Prison

Cited by 10 publications

References 30 publications

Analysis of antipsychotic drugs prescribing in incarcerated persons in a Serbian correctional facility

Analysis of antipsychotic drugs prescribing in incarcerated persons in a Serbian correctional facility

Psychiatric and legal considerations for ketamine treatment within prison settings

Psychological screening service for men newly admitted to an Italian prison: Preliminary clinical outcome analysis after 1 year of clinical activity

Contact Info

Product

Resources

About