Abstract
Background: Nonadherence to medication is prevalent in persons diagnosed with schizophrenia, thus increasing the likelihood of relapse, poor health outcomes, hospitalization, high treatment costs, and high rates of both violent and non-violent offenses.Objective: To assess the association between long-acting injectable (LAI) antipsychotic use and criminal justice system encounters in patients with schizophrenia or schizoaffective disorder.Methods: This retrospective follow-up study was conducted among patients aged ≥18 years treated for schizophrenia or schizoaffective disorder at a community mental health center in Akron, Ohio, between January 1, 2010, and June 15, 2016. The incidence of criminal justice system encounters at 6 months, 1 year, and 2 years pre- versus post-LAI antipsychotic initiation was assessed. A subanalysis was conducted for individuals with a history of prior arrest.Results: Overall, the risk ratio (RR) of having an encounter with the criminal justice system was significantly lower for patients treated with LAI antipsychotics 1 year after initiation of treatment compared with a similar time period prior to initiation (RR [95% confidence interval (CI)]: 0.74 [0.59–0.93]; P<0.01) and 2 years (0.74 [0.62–0.88]; P<0.0001). Statistically significant reductions in criminal justice system encounters after treatment than before treatment were observed in the once-monthly paliperidone palmitate (PP1M) cohort. The incidence of arrests was lower in the 6-month (27 vs 85 arrests), 1-year (46 vs 132 arrests) and 2-year (88 vs 196 arrests) periods post-index LAI medication than in the corresponding periods pre-index LAI medication among individuals with a history of prior arrest.Conclusions: Patients with schizophrenia or schizoaffective disorder who were initiated on a LAI antipsychotic medication, specifically PP1M, were less likely to have an encounter with the criminal justice system compared with a similar time period before the initiation of LAI treatment.
Highlights
People with mental health disorders have a high incidence of poverty, unemployment, crime, victimization, family breakdown, homelessness, substance use, physical health problems, and stigma.[1]
Overall, the risk ratio (RR) of having an encounter with the criminal justice system was significantly lower for patients treated with long-acting injectable (LAI) antipsychotics 1 year after initiation of treatment compared with a similar time period prior to initiation (RR [95% confidence interval (CI)]: 0.74 [0.59–0.93]; P
Patients with schizophrenia or schizoaffective disorder who were initiated on a LAI antipsychotic medication, PP1M, were less likely to have an encounter with the criminal justice system compared with a similar time period before the initiation of LAI treatment
Summary
People with mental health disorders have a high incidence of poverty, unemployment, crime, victimization, family breakdown, homelessness, substance use, physical health problems, and stigma.[1]. Access to and consistent use of antipsychotic medications is an integral component of the clinical management of schizophrenia.[4] Discontinuation is one of the main reasons for the lack of effectiveness of antipsychotic medication.[5] Patients with schizophrenia often have poor adherence to antipsychotic medication, with up to 50% either partially adherent or non-adherent within 1 year after discharge from the hospital setting.[6] Poor adherence to antipsychotic medication increases the likelihood of relapse, leading to poor health outcomes, a high risk of hospitalization, high treatment costs,[7,8] and high rates. Nonadherence to medication is prevalent in persons diagnosed with schizophrenia, increasing the likelihood of relapse, poor health outcomes, hospitalization, high treatment costs, and high rates of both violent and non-violent offenses
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