Psychiatria pre prax 3/2017

Long-acting injectable antipsychotics for prevention and management of violent behavior and aggression in patients with psychosis

Although aggressive and violent behavior is not a typical manifestation of schizophrenia or other psychotic disorders, psychosis increases the risk of violence. One of the modifiable factors of violence is adherence with medication. Long-term antipsychotic treatment prevents relapse, lowers number of rehospitalizations, and also effectively reduces violent and aggressive behavior. By contrast, nonadherence with drug treatment and subsequent relapse potentially increases risk of violent and aggressive acts. Nonadherence can be addressed partially by long-acting injectable antipsychotics (LAI). Empirical evidence from clinical practice, post-hoc analyses of clinical trials, and case series suggest that secured drug treatment with LAI significantly reduces violent behavior, number of incidents, and serious criminality of psychiatric patients. Thus, LAI can be advantageous in forensic psychiatry, especially during court-ordered commitment treatment.

Keywords: schizophrenia, violence, aggression, long-acting injectable antipsychotics (LAI), adherence