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Comparative Study
. 2020 May 27;23(5):300-310.
doi: 10.1093/ijnp/pyaa005.

Prescribing Patterns of Psychotropic Drugs and Risk of Violent Behavior: A Prospective, Multicenter Study in Italy

E di Giacomo  1   2 , A Stefana  3 , V Candini  4 , G Bianconi  5 , L Canal  6 , M Clerici  1   2 , G Conte  3 , M T Ferla  7 , L Iozzino  4 , G Sbravati  4 , G Tura  4 , R Micciolo  6 , G de Girolamo  4 ; VIORMED-2 Group
Collaborators, Affiliations
Comparative Study

Prescribing Patterns of Psychotropic Drugs and Risk of Violent Behavior: A Prospective, Multicenter Study in Italy

E di Giacomo et al. Int J Neuropsychopharmacol. .

Abstract

Background: This prospective cohort study aimed at evaluating patterns of polypharmacy and aggressive and violent behavior during a 1-year follow-up in patients with severe mental disorders.

Methods: A total of 340 patients (125 inpatients from residential facilities and 215 outpatients) were evaluated at baseline with the Structured Clinical Interview for DSM-IV Axis I and II, Brief Psychiatric Rating Scale, Specific Levels of Functioning scale, Brown-Goodwin Lifetime History of Aggression, Buss-Durkee Hostility Inventory, Barratt Impulsiveness Scale, and State-Trait Anger Expression Inventory-2. Aggressive behavior was rated every 15 days with the Modified Overt Aggression Scale and treatment compliance with the Medication Adherence Rating Scale.

Results: The whole sample was prescribed mainly antipsychotics with high levels of polypharmacy. Clozapine prescription and higher compliance were associated with lower levels of aggressive and violent behavior. Patients with a history of violence who took clozapine were prescribed the highest number of drugs. The patterns of cumulative Modified Overt Aggression Scale mean scores of patients taking clozapine (n = 46), other antipsychotics (n = 257), and no antipsychotics (n = 37) were significantly different (P = .001). Patients taking clozapine showed a time trend at 1-year follow-up (24 evaluations) indicating a significantly lower level of aggressive behavior. Patient higher compliance was also associated with lower Modified Overt Aggression Scale ratings during the 1-year follow-up.

Conclusion: Both inpatients and outpatients showed high levels of polypharmacy. Clozapine prescription was associated with lower Modified Overt Aggression Scale ratings compared with any other antipsychotics or other psychotropic drugs. Higher compliance was associated with lower levels of aggressive and violent behavior.

Keywords: aggressive behavior; clozapine; polypharmacy; severe mental illness; violence.

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Figures

Figure 1.
Figure 1.
Cumulative means of total Modified Overt Aggression Scale (MOAS).
Figure 2.
Figure 2.
Cumulative means of total Modified Overt Aggression Scale (MOAS) in different pharmacological groups.
Figure 3.
Figure 3.
Cumulative means of total Modified Overt Aggression Scale (MOAS) in different clinical groups according to residential setting.
See this image and copyright information in PMC

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