Summary: A new study reports prescribing violent offenders psychotropic drugs following release from prison decreases the risk of the reoffending.
Source: University of Oxford.
A study by the University of Oxford, looking at rates of violent re-offences among former prisoners in Sweden, has shown that prescribing psychotropic medications can cut the risk of violent reoffending.
Prescribing ex-prisoners psychotropic medications after release is associated with a decrease in reoffending, according to a new study led by the University of Oxford.
The researchers looked at released prisoners from across Sweden between 2005 and 2010, who were prescribed antipsychotics, psychostimulants and drugs for addictive disorders, and followed until end of 2013. By comparing the periods when they were and were not prescribed these medications, the researchers were able to show a drop in the rate of violent reoffending while they were receiving treatment.
Of the 22,275 released prisoners in the study, 4,031 committed violent re-offences in the follow-up period, amounting to 5,653 individual incidents. Antipsychotic medications were associated with a 42% reduction in the rate of violent reoffending, psychostimulants with a 36% reduction in this rate, and for drugs used in addictive disorders there was 52% drop. No significant reductions were found for antidepressants or antiepileptic medications.
The study, published in the Journal of the American Medical Association, raises the possibility that prescribing psychotropic medications to individuals considered at particular risk offers a way of helping to re-integrate individuals into society, who may otherwise become trapped in a cycle of reoffending.
Wellcome Senior Research Fellow Professor Seena Fazel of the University of Oxford’s Department of Psychiatry, who led the research, said: ‘Many countries are keen to reduce the number of people in their prisons, but are unsure how to balance rehabilitation with protecting the public. This study raises the possibility that prescribed medications may provide a way to cut the risk of violent reoffending, as part of a wider package of support.
‘The research also highlighted that medications seem to work beyond their immediate effects on symptoms. We have shown that in a population with many mental health problems and high risks of reoffending, improving adherence and links with community health services may offer an effective way to improve outcomes for the individual prisoner and also public health and safety more broadly.’
The research team from the universities of Oxford, Örebro, Uppsala and the Karolinska Institutet, noted that further research is now needed to understand the nature of the association.
Source: University of Oxford
Image Source: NeuroscienceNews.com image is adapted from the University of Oxford press release.
Original Research: Abstract for “Triggers for Violent Criminality in Patients With Psychotic Disorders” by Amir Sariaslan, PhD; Paul Lichtenstein, PhD; Henrik Larsson, PhD; and Seena Fazel, MD in JAMA Psychiatry. Published online August 1 2016 doi:10.1001/jamapsychiatry.2016.1349
Triggers for Violent Criminality in Patients With Psychotic Disorders
mportance Absolute and relative risks of violence are increased in patients with psychotic disorders, but the contribution of triggers for violent acts to these risks is uncertain.
Objective To examine whether a range of triggers for violent acts are associated with risks of violence in patients diagnosed with psychotic disorders and in individuals without a psychiatric diagnosis.
Design, Setting, and Participants Using a sample of all individuals born in Sweden between 1958 and 1988 (N = 3 123 724), we identified patients in the National Patient Register who were diagnosed with schizophrenia spectrum disorders (n = 34 903) and bipolar disorder (n = 29 692), as well as unaffected controls (n = 2 763 012). We then identified, within each subsample, persons who had experienced any of the following triggers for violent acts between January 1, 2001, and December 15, 2013: exposure to violence, parental bereavement, self-harm, traumatic brain injury, unintentional injuries, and substance intoxication. By using within-individual models, we conducted conditional logistic regression to compare the risk of the individual engaging in violent acts in the week following the exposure to a trigger with the risk during earlier periods of equivalent length. All time-invariant confounders (eg, genetic and early environmental influences) were controlled for by this research design and we further adjusted for time-varying sociodemographic factors.
Main Outcomes and Measures Adjusted odds ratios (aORs) of violent crime occurring in the week following the exposure to a trigger event compared with earlier periods.
Results Among the sample of 2 827 607 individuals (1 492 186 male and 1 335 421 female), all of the examined trigger events were associated with increased risk of violent crime in the week following exposure. The largest 1-week absolute risk of violent crime was observed following exposure to violence (70-177 violent crimes per 10 000 persons). For most triggers, the relative risks did not vary significantly by diagnosis, including unintentional injuries (aOR range, 3.5-4.8), self-harm (aOR range, 3.9-4.2), and substance intoxication (aOR range, 3.0-4.0). Differences by diagnosis included parental bereavement, which was significantly higher in patients with schizophrenia spectrum disorders (aOR, 5.0; 95% CI, 3.0-8.1) compared with controls (aOR, 1.7; 95% CI, 1.3-2.2).
Conclusions and Relevance In addition to identifying risk factors for violence, clarifying the timing of the triggers may provide opportunities to improve risk assessment and management in individuals with psychotic disorders.
“Triggers for Violent Criminality in Patients With Psychotic Disorders” by Amir Sariaslan, PhD; Paul Lichtenstein, PhD; Henrik Larsson, PhD; and Seena Fazel, MD in JAMA Psychiatry. Published online August 1 2016 doi:10.1001/jamapsychiatry.2016.1349