title: Psychotropic prescribing in seriously violent men with schizophrenia or personality disorder in a UK high security hospital.
abstract: OBJECTIVE
  To analyze antipsychotic prescribing patterns in a UK high security hospital (HSH) that treats seriously violent men with either schizophrenia or personality disorder and examine how different groups consented to treatment and prescribing for metabolic conditions. We hypothesized that there would be high prevalence of antipsychotic polypharmacy, and high-dose antipsychotic and clozapine prescribing.
  
  
  BACKGROUND
  HSHs treat seriously violent, mentally disordered offenders, and the extant literature on prescribing patterns in forensic settings is sparse.
  
  
  METHODS
  Prescribing and clinical data on all 189 patients in a UK HSH were collected from the hospital's databases. Data were analyzed using SPSS.
  
  
  RESULTS
  The population was split into the following groups: schizophrenia spectrum disorder (SSD-only), personality disorder (PD-only), and comorbid schizophrenia spectrum disorder and PD. The majority (93.7%) of all patients were prescribed at least one antipsychotic, and (27.5%) were on clozapine. Polypharmacy was prevalent in 22.2% and high-dose antipsychotic in 27.5%. Patients on clozapine were more likely to be prescribed antidiabetic, statins, or antihypertensive medication. Patients in the PD-only group were more likely to be deemed to have the capacity to consent to treatment and be prescribed clozapine in contrast to the SSD-only group.
  
  
  CONCLUSIONS
  Rates of clozapine and high-dose antipsychotic prescribing were higher than in other psychiatric settings, while polypharmacy prescribing rates were lower. Higher clozapine prescribing rates may be a function of a treatment-resistant and aggressive population. A higher proportion of PD-only patients consented to treatment and received clozapine compared with in-house SSD-only as well as other psychiatric settings. Implications of the findings are discussed.
authors.affiliation: 1School of Medicine,University of Manchester,Manchester,UK.
authors.forename: Keir
authors.initials: K
authors.lastname: Stone-Brown
authors.affiliation: 2Medical Sciences Division,John Radcliffe Hospital,University of Oxford,Oxford,UK.
authors.forename: Mahmood
authors.initials: M
authors.lastname: Naji
authors.affiliation: 2Medical Sciences Division,John Radcliffe Hospital,University of Oxford,Oxford,UK.
authors.forename: Alex
authors.initials: A
authors.lastname: Francioni
authors.affiliation: 2Medical Sciences Division,John Radcliffe Hospital,University of Oxford,Oxford,UK.
authors.forename: Kyle
authors.initials: K
authors.lastname: Myers
authors.affiliation: 2Medical Sciences Division,John Radcliffe Hospital,University of Oxford,Oxford,UK.
authors.forename: Harsh
authors.initials: H
authors.lastname: Samarendra
authors.affiliation: 3Broadmoor High Secure Hospital,West London Mental Health NHS Trust,London,UK.
authors.forename: Haseeb
authors.initials: H
authors.lastname: Mushtaq-Chaudhry
authors.affiliation: 3Broadmoor High Secure Hospital,West London Mental Health NHS Trust,London,UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Heslop
authors.affiliation: 3Broadmoor High Secure Hospital,West London Mental Health NHS Trust,London,UK.
authors.forename: Samrat
authors.initials: S
authors.lastname: Sengupta
authors.affiliation: 3Broadmoor High Secure Hospital,West London Mental Health NHS Trust,London,UK.
authors.forename: Callum C
authors.initials: CC
authors.lastname: Ross
authors.affiliation: 3Broadmoor High Secure Hospital,West London Mental Health NHS Trust,London,UK.
authors.forename: Fintan
authors.initials: F
authors.lastname: Larkin
authors.affiliation: 3Broadmoor High Secure Hospital,West London Mental Health NHS Trust,London,UK.
authors.forename: Mrigendra
authors.initials: M
authors.lastname: Das
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D003024:Clozapine / Q000627:therapeutic use*; D057237:Criminals; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000453:epidemiology; D050171:Dyslipidemias / Q000188:drug therapy / Q000453:epidemiology; D006778:Hospitals, Psychiatric; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007258:Informed Consent; D008297:Male; D008875:Middle Aged; D010554:Personality Disorders / Q000188:drug therapy* / Q000453:epidemiology; D019338:Polypharmacy; D010818:Practice Patterns, Physicians'; D011618:Psychotic Disorders / Q000188:drug therapy* / Q000453:epidemiology; D012559:Schizophrenia / Q000188:drug therapy* / Q000453:epidemiology; D006113:United Kingdom; D014754:Violence
chemical_list: D000959:Antihypertensive Agents; D014150:Antipsychotic Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007004:Hypoglycemic Agents; D003024:Clozapine
keywords: High security hospital; mentally disordered offenders; personality disorder; prescribing; psychotropic medications; schizophrenia; violence