Summary: A new study finds that prescribing psychotropic medications to violent offenders after release from prison is associated with a reduced risk of violent reoffending.

Source: University of Oxford

Psychotropic Medications Linked to Lower Rates of Violent Reoffending

A large study led by the University of Oxford reports that prescribing psychotropic medications to people released from prison is associated with a reduced risk of violent reoffending.

Researchers examined a national cohort of people released from prison in Sweden between 2005 and 2010 and followed their outcomes through the end of 2013. The team compared periods when individuals were dispensed psychotropic medications with periods when the same individuals were not receiving these medications. This within-person design reduces confounding by characteristics that do not change over time and provides stronger evidence that medication periods were associated with lower rates of violent reoffending.

Among 22,275 people released from prison included in the analysis, 4,031 committed at least one violent reoffence during follow-up, totaling 5,653 violent incidents. The study evaluated different classes of psychotropic drugs. Antipsychotic treatment was associated with a 42% reduction in the rate of violent reoffending. Psychostimulant medications were associated with a 36% reduction, and medications used to treat addictive disorders were associated with a 52% reduction. No statistically significant associations were observed for antidepressants or antiepileptic drugs.

Seena Fazel, Wellcome Senior Research Fellow in the Department of Psychiatry at the University of Oxford and lead author of the study, commented that many countries are trying to reduce prison populations while protecting public safety. The findings raise the possibility that, alongside other support measures, targeted prescribing and better continuity of care after release could play a role in rehabilitation and public protection.

Fazel emphasized that the apparent benefits of medication extend beyond immediate symptom reduction. In a population with high rates of mental health problems and a substantial risk of reoffending, improving medication adherence and strengthening links between released individuals and community health services may improve individual outcomes and contribute to broader public health and safety.

The research team included collaborators from the universities of Oxford, Örebro, Uppsala and the Karolinska Institutet. The investigators note that further research is needed to better understand the mechanisms behind the associations observed and to identify which patients are most likely to benefit from pharmacological and accompanying psychosocial interventions after release.

About the Study

The study used national registers in Sweden and a within-person comparison design to reduce confounding by stable personal characteristics. By comparing the same individuals during treated and untreated periods, the researchers estimated the association between being prescribed psychotropic medication after release and the subsequent risk of violent offending.

Key findings:

• Antipsychotics: 42% reduction in violent reoffending rate during medicated periods.
• Psychostimulants: 36% reduction in violent reoffending rate during medicated periods.
• Medications for addictive disorders: 52% reduction in violent reoffending rate during medicated periods.
• No significant reductions observed for antidepressants or antiepileptic drugs.

The study was published in JAMA Psychiatry and highlights the potential value of integrating pharmacological treatment with community-based services as part of a comprehensive strategy to reduce violent reoffending among high-risk released prisoners.

Abstract Summary

The paper titled “Triggers for Violent Criminality in Patients With Psychotic Disorders” examined triggers for violent acts and their timing in a broad Swedish population sample. Using registry data for individuals born in Sweden from 1958 to 1988, the authors identified patients diagnosed with schizophrenia spectrum disorders and bipolar disorder, as well as an unaffected control group. They examined short-term risks of violent crime in the week following exposure to potential triggers—such as exposure to violence, parental bereavement, self-harm, traumatic brain injury, unintentional injuries, and substance intoxication—using within-individual conditional logistic regression models. The design controlled for all time-invariant confounders and adjusted for time-varying sociodemographic factors.

All examined trigger events were associated with increased short-term risk of violent crime. The largest absolute 1-week risk was observed after exposure to violence. For many triggers, relative risks were similar across diagnostic groups, although some differences emerged; for example, parental bereavement was associated with a substantially higher short-term risk of violent crime in those with schizophrenia spectrum disorders compared with controls.

The authors conclude that identifying and clarifying the timing of triggers for violent behavior can improve risk assessment and management in people with psychotic disorders, and that interventions timed to these vulnerable periods may reduce the risk of violent outcomes.

Source and Original Research

Source: University of Oxford.

Original research: “Triggers for Violent Criminality in Patients With Psychotic Disorders,” by Amir Sariaslan, Paul Lichtenstein, Henrik Larsson, and Seena Fazel, published in JAMA Psychiatry (online August 1, 2016), doi:10.1001/jamapsychiatry.2016.1349.