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terça-feira, 01 novembro 2016 12:27

Association Between Prescription of Major Psychotropic Medications and Violent Reoffending After Prison Release.

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Chang Z1, Lichtenstein P2 Långström N3 Larsson H4 Fazel S5

1
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden2Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, England.
2
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
3
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden3Department of Neuroscience, Uppsala University, Uppsala, Sweden.
4
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden4School of Medical Sciences, Örebro University, Örebro, Sweden.
5
Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, England.

JAMA

2016 Nov 1


Abstract:

IMPORTANCE: Individuals released from prison have high rates of violent reoffending, and there is uncertainty about whether pharmacological treatments reduce reoffending risk.

OBJECTIVE: To investigate the associations between major classes of psychotropic medications and violent reoffending.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study included all released prisoners in Sweden from July 1, 2005, to December 31, 2010, through linkage of population-based registers. Rates of violent reoffending during medicated periods were compared with rates during nonmedicated periods using within-individual analyses. Follow-up ended December 31, 2013.

EXPOSURES: Periods with or without dispensed prescription of psychotropic medications (antipsychotics, antidepressants, psychostimulants, drugs used in addictive disorders, and antiepileptic drugs) after prison release. Prison-based psychological treatments were investigated as a secondary exposure.

MAIN OUTCOMES AND MEASURES: Violent crime after release from prison.

RESULTS: The cohort included 22 275 released prisoners (mean [SD] age, 38 [13] years; 91.9% male). During follow-up (median, 4.6 years; interquartile range, 3.0-6.4 years), 4031 individuals (18.1%) had 5653 violent reoffenses. The within-individual hazard ratio (HR) associated with dispensed antipsychotics was 0.58 (95% CI, 0.39-0.88), based on 100 events in 1596 person-years during medicated periods and 1044 events in 11 026 person-years during nonmedicated periods, equating to a risk difference of 39.7 (95% CI, 11.3-57.7) fewer violent reoffenses per 1000 person-years. The within-individual HR associated with dispensed psychostimulants was 0.62 (95% CI, 0.40-0.98), based on 94 events in 1648 person-years during medicated periods and 513 events in 4553 person-years during nonmedicated periods, equating to a risk difference of 42.8 (95% CI, 2.2-67.6) fewer violent reoffenses per 1000 person-years. The within-individual HR associated with dispensed drugs for addictive disorders was 0.48 (95% CI, 0.23-0.97), based on 46 events in 1168 person-years during medicated periods and 1103 events in 15 725 person-years during nonmedicated periods, equating to a risk difference of 36.4 (95% CI, 2.1-54.0) fewer violent reoffenses per 1000 person-years. In contrast, antidepressants and antiepileptics were not significantly associated with violent reoffending rates (HR = 1.09 [95% CI, 0.83-1.43] and 1.14 [95% CI, 0.79-1.65], respectively). The most common prison-based program was psychological treatments for substance abuse, associated with an HR of 0.75 (95% CI, 0.63-0.89), which equated to a risk difference of 23.2 (95% CI, 10.3-34.1) fewer violent reoffenses per 1000 person-years.

CONCLUSIONS AND RELEVANCE: Among released prisoners in Sweden, rates of violent reoffending were lower during periods when individiduals were dispensed antipsychotics, psychostimulants, and drugs for addictive disorders, compared with periods in which they were not dispensed these medications. Further research is needed to understand the causal nature of this association.


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