Abstract
OBJECTIVEWe observed a pattern of combining depot antipsychotic medication with the newer ‘atypical’ antipsychotics in forensic patients. We aimed to determine the prevalence and rationale for such ‘combination therapy’.METHODThe medical records of forensic patients in 3 forensic hospitals in New South Wales, Australia, were reviewed and the responsible psychiatrists asked to explain the rationale for treatment of those patients on combination therapy.ResultsTwenty-two per cent of the forensic patient population were receiving combination therapy. The reasons given for combination therapy were the presence of treatment-resistant illness, to ensure adherence to at least part of the treatment and to assist transfer to lower security units.CONCLUSIONSSuch a high prevalence of a practice that is discouraged and without theoretical justification is a cause for concern. It appeared to reflect the practical difficulties of managing forensic patients.
Highlights
We observed a pattern of combining depot antipsychotic medication with the newer ‘atypical’ antipsychotics in forensic patients
Such a high prevalence of a practice that is discouraged and without theoretical justification is a cause for concern. It appeared to reflect the practical difficulties of managing forensic patients
Forensic patients in New South Wales are either unfit to be tried, have been found not guilty of a serious offence on the grounds of mental illness or have been transferred to hospital because their illness could not be adequately managed in the mainstream prison setting
Summary
The medical records of forensic patients in 3 forensic hospitals in New South Wales, Australia, were reviewed and the responsible psychiatrists asked to explain the rationale for treatment of those patients on combination therapy. Long Bay Hospital is a 90-bed maximum-security psychiatric hospital built in 1985 in the grounds of the largest prison complex in New South Wales. The forensic wards of Cumberland and Morisset Psychiatric Hospitals have 24 beds each, described as medium-security, and they usually accept forensic patients from the more secure setting. The medical records of patients in all three hospitals were reviewed, with particular note being taken of diagnosis, duration of illness and the antipsychotic medication prescribed. For each patient receiving a combination therapy, the responsible psychiatrist was asked to complete a brief questionnaire to explain the reasons for giving this medication. Data were collected from a group of 40 treatmentresistant patients living in three supervised group homes in the community
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