di Giacomo E, Stefana A, Candini V, Bianconi G, Canal L, Clerici M, Conte G, Ferla MT, Iozzino L, Sbravati G, Tura G, Micciolo R, de Girolamo G. Int. J. Neuropsychopharmacol. 2020; ePub(ePub): ePub.
Affiliation
Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Via Pilastroni 4, Brescia, Italy.
BACKGROUND: This prospective cohort study aimed at evaluating patterns of polypharmacy, aggressive and violent behaviour during a 1-year follow-up (FU) in patients with severe mental disorders.
METHODS: 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 behaviour was rated every fifteen days with the Modified Overt Aggression Scale (MOAS); treatment compliance with the Medication Adherence Rating Scale (MARS).
RESULTS: The whole sample was prescribed mainly antipsychotics (APs) with high levels of polypharmacy. Clozapine prescription and higher compliance were associated with lower levels of aggressive and violent behaviour. Patients with a history of violence who took clozapine were prescribed the highest number of drugs. The patterns of cumulative MOAS mean scores of patients taking clozapine (N = 46), other APs (N = 257), and no APs (N = 37) were significantly different (p =.001). Patients taking clozapine showed a time trend at 1-year FU (24 evaluations) indicating a significantly lower level of aggressive behaviour. Patient higher compliance was also associated with lower MOAS ratings during the 1-year FU.
CONCLUSION: Both inpatients and outpatients showed high levels of polypharmacy. Clozapine prescription was associated with lower MOAS ratings compared with any other APs or other psychotropic drugs. Higher compliance was associated with lower levels of aggressive and violent behaviour.