title: Risk of arrest in persons with schizophrenia and bipolar disorder in a Florida Medicaid program: the role of atypical antipsychotics, conventional neuroleptics, and routine outpatient behavioral health services.
abstract: OBJECTIVE
  To examine (1) arrest outcomes for adults with schizophrenia and bipolar disorder who were treated with first-generation antipsychotics (FGAs) or second-generation atypical antipsychotics (SGAs) and (2) the interaction between medication class and outpatient services in a Florida Medicaid program.
  
  
  METHODS
  In a secondary data analysis, Florida Medicaid data covering the period from July 1, 2002, to March 31, 2008, were used to identify persons diagnosed with schizophrenia, schizoaffective disorder, and bipolar disorder and to examine antipsychotic medication episodes lasting at least 60 days. There were 93,999 medication episodes in the population examined (N = 36,519). Medication episodes were coded as (1) SGA-aripiprazole, clozapine, olanzapine, paliperidone, quetiapine, risperidone, risperidone long-acting therapy, or ziprasidone; or (2) FGA-any other antipsychotic medication. Outpatient services were defined as the proportion of 30-day periods of each medication episode with at least 1 behavioral health visit. Survival analyses were used to analyze the data, and they were adjusted for the baseline propensity for receiving an SGA.
  
  
  RESULTS
  Second-generation antipsychotic episodes were not associated with reduced arrests compared to FGA episodes; however, the interaction between outpatient services and SGA episodes was significant (hazard ratio [HR] = 0.68; 95% CI, 0.50-0.93; P = .02) such that an SGA episode with an outpatient visit during at least 80% of every 30-day period of the episode was associated with reduced arrests compared to SGA episodes with fewer outpatient services. There was no significant effect for concurrent FGA episodes and outpatient treatment (HR = 0.81; 95% CI, 0.60-1.10; P = .18). Substance use, poor refill compliance, and prior arrest increased risk of subsequent arrest.
  
  
  CONCLUSIONS
  The interaction between outpatient visits and treatment with SGAs was significantly associated with reduced arrests. These findings indicate the importance of concurrent antipsychotic medications and outpatient services to affect arrest outcomes for adults with schizophrenia and bipolar disorder.
authors.affiliation: Department of Mental Health Law & Policy, Florida Mental Health Institute, College of Behavioral & Community Sciences, University of South Florida, 13301 Bruce B. Downs Blvd, MHC 2718, Tampa, FL 33612, USA. rvandorn@fmhi.usf.edu
authors.forename: Richard A
authors.initials: RA
authors.lastname: Van Dorn
authors.forename: Ross
authors.initials: R
authors.lastname: Andel
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Boaz
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Desmarais
authors.forename: Kristen
authors.initials: K
authors.lastname: Chandler
authors.forename: Marion A
authors.initials: MA
authors.lastname: Becker
authors.forename: Andrew
authors.initials: A
authors.lastname: Howe
mesh_terms: D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D000068180:Aripiprazole; D001569:Benzodiazepines / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy / Q000453:epidemiology*; D003024:Clozapine / Q000627:therapeutic use; D003415:Crime / Q000517:prevention & control / Q000523:psychology* / Q000706:statistics & numerical data; D003692:Delayed-Action Preparations; D003987:Dibenzothiazepines / Q000627:therapeutic use; D005260:Female; D005431:Florida / Q000453:epidemiology; D006801:Humans; D007555:Isoxazoles / Q000627:therapeutic use; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D008875:Middle Aged; D000077152:Olanzapine; D010045:Outpatients / Q000523:psychology / Q000706:statistics & numerical data; D000068882:Paliperidone Palmitate; D010879:Piperazines / Q000627:therapeutic use; D057216:Propensity Score; D011743:Pyrimidines / Q000627:therapeutic use; D000069348:Quetiapine Fumarate; D015363:Quinolones / Q000627:therapeutic use; D012307:Risk Factors; D018967:Risperidone / Q000008:administration & dosage / Q000627:therapeutic use; D012559:Schizophrenia / Q000188:drug therapy / Q000453:epidemiology*; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents; D003692:Delayed-Action Preparations; D003987:Dibenzothiazepines; D007555:Isoxazoles; D010879:Piperazines; D011743:Pyrimidines; D015363:Quinolones; D001569:Benzodiazepines; D000069348:Quetiapine Fumarate; D000068180:Aripiprazole; D003024:Clozapine; D018967:Risperidone; D000077152:Olanzapine; D000068882:Paliperidone Palmitate