Psychiatric treatment against violent crimes among released prisoners

Published 2016-11-02 08:47. Updated 2016-11-02 09:26Denna sida på svenska

Repeated violent crimes in released prisoners can be prevented with effective psychiatric treatment, according to an article published in the international journal JAMA.

 In a large registry study published in The Journal of the American Medical Association (JAMA), researchers from Karolinska Institutet and University of Oxford show that rates of violent reoffending in certain groups of released prisoners dropped substantially during periods when they were on psychotropic medications (antipsychotics, stimulants, or medications for addictive disorders).

Individuals released from prison have high rates of violent reoffending. While psychiatric and substance use disorders are overrepresented among jail and prison populations, it has remained uncertain whether treatment with psychotropic medications reduces violent recidivism. By studying more than 22,000 released prisoners over an eight-year period (2005-2013), researchers have now been able to examine the associations between major classes of psychotropic medications and violent reoffending.

Results demonstrate that rates of violent reoffending decreased

The results from the current study demonstrate that rates of violent reoffending decreased by 42% when individuals were receiving antipsychotics after release, by 38% when dispensed psychostimulants, and by 52% when receiving medications for addictive disorders. These were done by comparing individuals to themselves (i.e. during periods with and without medication), as a way to reduce bias from individual difference in selection into treatment.

"We have shown that three classes of psychotropic medications (antipsychotics, psychostimulants, and medications used for addictive disorders) may reduce violent reoffending," says Zheng Chang, postdoctoral researcher at the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet. "However, it is also important to note that many psychotropic medications can have adverse side effects, so our findings should be considered along with other potential benefits and harms associated with these medications, including potential diversion and misuse.”

Enhancing medication after prison release needs evaluation

For comparison, the researchers secondarily investigated the associations of prison-based psychological treatments with violent reoffending. Results suggested the magnitudes of the reduction associated with psychotropic medications were as strong as and possibly stronger than for widely disseminated psychological programs in prison. 

“Enhancing medication after prison release needs evaluation as a possibly cost-effective crime reduction alternative,” says Zheng Chang. “Because of the high prevalence of psychiatric and substance use disorder among prisoners and strong links with premature mortality, effective treatments for them could also have a substantial public health benefit.”

The study was based on observational data, so caution is warranted in interpreting these results. Further research is needed to understand the causal nature of this association.

The study was financed with grants from the Wellcome Trust, the Swedish Research Council, the Swedish Research Council for Health, Working Life and Welfare, the Swedish Initiative for Research on Microdata in the Social and Medical Sciences (SIMSAM) framework, the European Union Seventh Framework Programme, and the National Institute of Mental Health.

Publication

"Association between prescription of major psychotropic medications and violent reoffending after prison release"

Zheng Chang, Paul Lichtenstein, Niklas Långström, Henrik Larsson, Seena Fazel

JAMA, published 1 November 2016.  doi:10.1001/jama.2016.15380