Antipsychotics, mood stabilisers, and risk of violent crime

• Published in: The Lancet (British edition) Vol. 384; no. 9949; pp. 1206 - 1214
• Main Authors: Fazel, Seena, Dr, Zetterqvist, Johan, MSc, Larsson, Henrik, PhD, Långström, Niklas, Prof, Lichtenstein, Paul, Prof
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 27-09-2014; Elsevier; Elsevier Limited
• Subjects: Adolescent; Adult; Aged; Antipsychotic Agents - adverse effects; Antipsychotics; Biological and medical sciences; Bipolar disorder; Crime - statistics & numerical data; Female; General aspects; Humans; Internal Medicine; Male; Medical sciences; Medicin och hälsovetenskap; Mental disorders; Middle Aged; Neuropharmacology; Patients; Pharmacology. Drug treatments; Prevention; Psycholeptics: tranquillizer, neuroleptic; Psychology. Psychoanalysis. Psychiatry; Psychopharmacology; Psychotropic drugs; Ratios; Registries; Risk Factors; Schizophrenia; Sensitivity analysis; Studies; Sweden - epidemiology; Tranquilizing Agents - adverse effects; Violence; Violence - statistics & numerical data; Violent crime; Young Adult; Sweden; Medicine; Mood; Neuroleptic; Psychotropic; Violence; Crime; Risk factor; Antipsychotic; Risk; Murder
• ISSN: 0140-6736; 1474-547X; 1474-547X
• DOI: 10.1016/S0140-6736(14)60379-2

Summary Background Antipsychotics and mood stabilisers are prescribed widely to patients with psychiatric disorders worldwide. Despite clear evidence for their efficacy in relapse prevention and symptom relief, their effect on some adverse outcomes, including the perpetration of violent crime, is unclear. We aimed to establish the effect of antipsychotics and mood stabilisers on the rate of violent crime committed by patients with psychiatric disorders in Sweden. Methods We used linked Swedish national registers to study 82 647 patients who were prescribed antipsychotics or mood stabilisers, their psychiatric diagnoses, and subsequent criminal convictions in 2006–09. We did within-individual analyses to compare the rate of violent criminality during the time that patients were prescribed these medications versus the rate for the same patients while they were not receiving the drugs to adjust for all confounders that remained constant within each participant during follow-up. The primary outcome was the occurrence of violent crime, according to Sweden's national crime register. Findings In 2006–09, 40 937 men in Sweden were prescribed antipsychotics or mood stabilisers, of whom 2657 (6·5%) were convicted of a violent crime during the study period. In the same period, 41 710 women were prescribed these drugs, of whom 604 (1·4 %) had convictions for violent crime. Compared with periods when participants were not on medication, violent crime fell by 45% in patients receiving antipsychotics (hazard ratio [HR] 0·55, 95% CI 0·47–0·64) and by 24% in patients prescribed mood stabilisers (0·76, 0·62–0·93). However, we identified potentially important differences by diagnosis—mood stabilisers were associated with a reduced rate of violent crime only in patients with bipolar disorder. The rate of violence reduction for antipsychotics remained between 22% and 29% in sensitivity analyses that used different outcomes (any crime, drug-related crime, less severe crime, and violent arrest), and was stronger in patients who were prescribed higher drug doses than in those prescribed low doses. Notable reductions in violent crime were also recorded for depot medication (HR adjusted for concomitant oral medications 0·60, 95% CI 0·39–0·92). Interpretation In addition to relapse prevention and psychiatric symptom relief, the benefits of antipsychotics and mood stabilisers might also include reductions in the rates of violent crime. The potential effects of these drugs on violence and crime should be taken into account when treatment options for patients with psychiatric disorders are being considered. Funding The Wellcome Trust, the Swedish Prison and Probation Service, the Swedish Research Council, and the Swedish Research Council for Health, Working Life and Welfare.