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Pharmacological Treatment in Forensic Psychiatry-A Systematic Review.
Howner, Katarina; Andiné, Peter; Engberg, Göran; Ekström, Emin Hoxha; Lindström, Eva; Nilsson, Mikael; Radovic, Susanna; Hultcrantz, Monica.
Afiliação
  • Howner K; Department of Clinical Neuroscience, Centre of Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.
  • Andiné P; Department for Forensic Psychiatry, National Board of Forensic Medicine, Stockholm, Sweden.
  • Engberg G; Department for Forensic Psychiatry, National Board of Forensic Medicine, Gothenburg, Sweden.
  • Ekström EH; Centre for Ethics, Law and Mental Health, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
  • Lindström E; Forensic Psychiatric Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden.
  • Nilsson M; Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
  • Radovic S; Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU), Stockholm, Sweden.
  • Hultcrantz M; Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden.
Front Psychiatry ; 10: 963, 2019.
Article em En | MEDLINE | ID: mdl-32009993
ABSTRACT

Background:

Pharmacological treatment is of great importance in forensic psychiatry, and the vast majority of patients are treated with antipsychotic agents. There are several systematic differences between general and forensic psychiatric patients, e.g. severe violent behavior, the amount of comorbidity, such as personality disorders and/or substance abuse. Based on that, it is reasonable to suspect that effects of pharmacological treatments also may differ. The objective of this systematic review was to investigate the effects of pharmacological interventions for patients within forensic psychiatry.

Methods:

The systematic review protocol was pre-registered in PROSPERO (CRD42017075308). Six databases were used for literature search on January 11, 2018. Controlled trials from forensic psychiatric care reporting on the effects of antipsychotic agents, mood stabilizers, benzodiazepines, antidepressants, as well as pharmacological agents used for the treatment of addiction or ADHD, were included. Two authors independently reviewed the studies, evaluated risk of bias and assessed certainty of evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE).

Results:

The literature search resulted in 1783 records (titles and abstracts) out of which 10 studies were included. Most of the studies included were retrospective and non-randomized. Five of them focused on treatment with clozapine and the remaining five on other antipsychotics or mood stabilizers. Five studies with a high risk of bias indicated positive effects of clozapine on time from treatment start to discharge, crime-free time, time from discharge to readmission, improved clinical functioning, and reduction in aggressive behavior. Psychotic symptoms after treatment were more pronounced in the clozapine group. Mainly due to the high risk of bias the reliability of the evidence for all outcomes was assessed as very low.

Conclusion:

This systematic review highlights the shortage of knowledge on the effectiveness of pharmacological treatment within forensic psychiatry. Due to very few studies being available in this setting, as well as limitations in their execution and reporting, it is challenging to overview the outcomes of pharmacological interventions in this context. The frequent use of antipsychotics, sometimes in combination with other pharmacological agents, in this complex and heterogeneous patient group, calls for high-quality studies performed in this specific setting.
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Texto completo: 1 Base de dados: MEDLINE Idioma: En Ano de publicação: 2019 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Idioma: En Ano de publicação: 2019 Tipo de documento: Article