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. 2022 Jun 10;12(3):175-180.
doi: 10.9740/mhc.2022.06.175. eCollection 2022 Jun.

Antipsychotic factors related to time to competency for forensic inpatients in a state psychiatric facility

Amber Lemons  1 , Courtney A Iuppa  1   2   3   4   3   5   6   7 , Carrie R Kriz  2 , Lauren A Diefenderfer  3 , Leigh Anne Nelson  4 , Shelby E Lang  3 , Ellie S R Elliott  5 , Joseph Moon  6 , Roger W Sommi  7
Affiliations

Antipsychotic factors related to time to competency for forensic inpatients in a state psychiatric facility

Amber Lemons et al. Ment Health Clin. .

Abstract

Introduction: A defendant who is deemed incompetent to stand trial may go through competency restoration consisting of mental health treatment and legal education. Antipsychotics are often used in treatment; however, there is little data examining their role.

Methods: This retrospective study included subjects opined competent to stand trial from July 2016 to February 2020 and prescribed an antipsychotic. The primary outcome was difference in time to competency between antipsychotics. Secondary outcomes included difference in time to competency between groups of antipsychotics, difference in length of stay after opined competent based on medication availability in jail, individual antipsychotics, and formulations.

Results: There were 117 subjects included for analysis. There were no differences in time to competency between individual antipsychotics, first- and second-generation antipsychotics, or formulations. Length of stay after opined competent was significantly longer for subjects who were prescribed a long-acting injectable antipsychotic (103 days vs 56 days), who were not able to receive their antipsychotic in jail (104 days vs 54 days), or who were prescribed any formulation of paliperidone compared with olanzapine (88 days vs 35 days).

Discussion: Since there were no differences in time to competency, patient-specific factors should be used to choose an agent for competency restoration. Length of stay differences are likely related to the antipsychotic access differences between jails and state psychiatric facilities. Therefore, policies related to antipsychotic access should better align between state psychiatric facilities and jails to improve the capacity of the system and provide better care.

Keywords: antipsychotics; bipolar disorder; competency; forensic psychiatry; jail; schizophrenia.

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Conflict of interest statement

Disclosures: The authors do not have a financial interest/arrangement or affiliation with 1 or more organizations that could be perceived as a real or apparent conflict of interest in the context of the subject of this study.

Figures

FIGURE 1
FIGURE 1
Average time to competency between antipsychotics (ARI = aripiprazole; HAL = haloperidol; OLZ = olanzapine; PAL = paliperidone; RIS = risperidone); all comparisons were not significant; 7 subjects were not included in analysis owing to low group sizes for their antipsychotic: chlorpromazine (n = 1), clozapine (n = 2), loxapine (n = 2), and quetiapine (n = 2)
FIGURE 2
FIGURE 2
Average length of stay after competency restoration (ARI = aripiprazole; HAL = haloperidol; OLZ = olanzapine; PAL = paliperidone; RIS = risperidone; * P < .01)
See this image and copyright information in PMC

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