[Psychopharmocotherapy of schizophrenia in forensic and general psychiatry].

OBJECTIVE: In general psychiatry, the treatment of schizophrenic psychoses is focused on the reduction of symptoms, the improvement of quality of life and the recovery of the capacity to work. In forensic psychiatry, a further major targets is the reduction of aggressive behavior - not least by the establishment of a stable adherence to medication. It is unclear until now, whether this leads to different psychopharmacological treatment strategies.

METHOD: The study includes 91 patients from the Psychiatric University Clinic Vienna (PUC) and 116 patients from the Justizanstalt Göllersdorf (JAGÖ), Austrian's central institution for the treatment of mentally disordered offenders not guilty by reason of insanity. We compared dosage, way of administration (oral, depot) and additional other medication. For both groups the chlorpromazine-equivalents were calculated. Additionally, combinations of different antipsychotic drugs and those of antipsychotics with medication of other substance classes (antidepressants, mood-stabilizers, benzodiazepines, anticholinergics) were compared.

RESULTS: Forensic patients were statistically significantly more often treated with intramuscular long-acting antipsychotics (LAI). Surprisingly, the total chlorpromazine-equivalents did not differ between the groups. Combinations of two or more antipsychotics were common in both groups, in the JAGÖ frequently as a combination of a first generation depot antipsychotic drug (FGA) with oral second genera tion antipsychotics (SGA), in the PUC more as often a combination of two or more oral SGA. Antidepressants and benzodiazepines were more frequently prescribed in the PUC, anticholinergics in the JAGÖ.

CONCLUSION: Patients suffering from schizophrenia are often non-compliant to medication. As nonadherence is a strong predictor for criminal offences, LAI-formulations are an important treatment tool in forensic psychiatry. This does not result in higher dosages. The high rates of polypharmacy in both groups emphasizes the well known problem that therapeutic guidelines based on studies in highly selected samples are often not transferable into everyday clinical practice.