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SO183

Association of psychotropic medications with the use of coercive measures and recidivism during forensic psychiatric care: A Swedish nationwide register-based study

THE ASSOCIATION OF PSYCHOTROPIC MEDICATIONS AND THE USE OF COERCIVE MEASURES AND RECIDIVISM DURING FORENSIC PSYCHIATRIC CARE: A SWEDISH NATIONWIDE REGISTER-BASED STUDY

In forensic psychiatric care, atypical antipsychotics, particularly clozapine, were associated with a reduced risk of both coercive measures and recidivism.

The study aimed to estimate the associations of different classes of psychotropic medications with the use of coercive measures and recidivism during forensic psychiatric care. In a nationwide register-based observational study covering all patients newly admitted to forensic psychiatric care in Sweden between 01/2009 and 08/2024, periods of exposure and non-exposure were compared using within-individual analyses with conditional generalized estimating equation models. A total of 2,690 patients were included; 82.7% of the sample were male, and 77.4% had a diagnosis of a schizophrenia spectrum disorder. Coercive measures (physical restraint, seclusion, forced medication) were used in 25.1% of patients, and 27.1% reoffended. Atypical antipsychotics were associated with a reduced risk of coercive measures (OR 0.70; 95% CI 0.55–0.89) and recidivism (OR 0.79; 95% CI 0.63–0.99), while medications for substance use disorders were associated with a reduced risk of coercive measures (OR 0.66; 95% CI 0.47–0.93). Among individual agents, clozapine showed the largest risk reduction (coercive measures: OR 0.48; 95% CI 0.33–0.69; recidivism: OR 0.49; 95% CI 0.33–0.74); olanzapine had an OR of 0.67 (95% CI 0.52–0.85) for coercive measures. Antipsychotic non-use was associated with an increased risk of both outcomes compared with oral monotherapy (coercive measures: OR 1.84; 95% CI 1.31–2.60; recidivism: OR 1.72; 95% CI 1.25–2.38); no significant differences were found between long-acting injectable treatment, oral monotherapy, and oral polytherapy. These findings may inform decision-making regarding the choice of pharmacotherapy in forensic psychiatric settings; however, pharmacotherapy should be viewed as only one of the many factors influencing treatment success.

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