Antipsychotic medications and convictions for violent crimes

One of the aims of the EU-VIORMED project is to assess effective treatments for people suffering from mental disorders who are at risk of violence and crime. Clarifying the gradient of effectiveness for medications is important to inform clinical decision-making thereby improving the quality of forensic psychiatric care for patients across Europe.

A recent observational study by Sariaslan and colleagues, published in Psychological Medicine (2020 Impact Factor: 5.813) a few weeks ago, investigated the associations between antipsychotic prescriptions andthe risk of arrests and convictions for violent and other crimes in a Swedish nationwide cohort of 74,925 individuals between 2006 and 2013.

By comparing rates of arrests and convictions for violent crime, substance-related crime, and any crime between periods when each individual was either on or off medication, the authors aimed at examining antipsychotic effectiveness on crime-prevention in a real-world setting. Within-subjects analyses were also performed. The relative risks of all crime outcomes were found to be substantially lower during periods when the patients were prescribed antipsychotics vs. periods when they were not. With specific regard to violent crimes, the authors found that antipsychotic prescriptions were associated with a 53% rate of reduction in violent arrests (adjusted Rate Ratio (aRR) = 0.47, 95% Confidence Interval (CI): 0.46–0.49) and a 50% rate reduction for violent crime convictions (aRR = 0.50, 95% CI: 0.47 to 0.54). A lower risk of violent offences was also estimated when the comparisons were made at the within-subject level, with antipsychotic prescriptions associated with a 43% rate reduction (aRR = 0.57, 95% CI: 0.55 to 0.59). The magnitude of the associations with violent crime arrests and convictions was stronger in people diagnosed with psychotic disorders (N = 42,184) as compared with their counterpart (N = 32,768). As far as the associations between individual antipsychotics and violent crimes risk are concerned, heterogeneity was found, with clozapine, olanzapine, risperidone, and long-acting injectable antipsychotics (especially risperidone) correlating with larger reductions in violent arrest rates than other commonly prescribed oral antipsychotics such as quetiapine and haloperidol.

These findings highlight the importance of adequate antipsychotic treatment to reduce the risk of arrests and convictions for violent and other crimes and may assist the clinicians in the development of personalized therapeutic programs, especially for individuals suffering from psychotic disorders.

Considering the potential bias of the estimates due to time-varying confounders, medication non-adherence, and possible reverse causation, large-scale clinical studies are needed in order to better investigate these associations.

The article full text is available here

Full reference:

Sariaslan A, Leucht S, Zetterqvist J, Lichtenstein P, Fazel S. Associations between individual antipsychotics and the risk of arrests and convictions of violent and other crime: a nationwide within-individual study of 74 925 persons. Psychol Med. 2021 Mar 11:1-9. doi: 10.1017/S0033291721000556. Epub ahead of print.