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• W2081310080 abstract "Seema Fazel and colleagues1Fazel S Zetterqvist J Larsson H Långström N Lichtenstein P Antipsychotics, mood stabilisers, and risk of violent crime.Lancet. 2014; 384: 1206-1214Summary Full Text Full Text PDF PubMed Scopus (129) Google Scholar deserve credit for their epidemiological study. However, some issues merit further discussion. Were non-compliant patients excluded from within-individual analyses, thus missing patients who might have had severe psychopathology and, hence, a high risk of violence and crime rates, leading to an inherent selection bias in the study sample?2Hodgins S Riaz M Violence and phases of illness: differential risk and predictors.Eur Psychiatry. 2011; 26: 518-524Summary Full Text Full Text PDF PubMed Scopus (43) Google Scholar Moreover, type and phase of illness were not mentioned, which are both known to affect the risk of violent behaviour and subsequent crime rates.3Bobes J Fillat O Arango C Violence among schizophrenia out-patients compliant with medication: prevalence and associated factors.Acta Psychiatr Scand. 2009; 119: 218-225Crossref PubMed Scopus (41) Google ScholarSufficient evidence exists to suggest that substance misuse complicates and confounds aggressive behaviour across the range of mental disorders.4Dolan M O'Malley K McGregor K The role of psychopathic traits and substance abuse in predicting violent victimization in patients with schizophrenia spectrum disorders.Personal Ment Health. 2013; 7: 28-38Crossref PubMed Scopus (9) Google Scholar The authors did mention rates of substance misuse, but their possible confounding effects deserve more discussion. The paradoxical issue of benzodiazepine both inducing and reducing agitation in patients was also left unaddressed.In their study, Fazel and colleagues also showed additional benefit of the use of an antipsychotic rather than a mood stabiliser for reduction of violence and crime rates. However, they did not mention whether the patients were on single or multiple antipsychotics, which could affect study outcomes and results interpretation. Finally, their claim of the study's superiority compared with previous works should be taken with caution. We feel that the authors could have substantially increased the validity of their findings by asking a few questions from patients or their immediate caregivers related to compliance, domestic violence, effect of hospitalisation, and substance misuse.We declare no competing interests. Seema Fazel and colleagues1Fazel S Zetterqvist J Larsson H Långström N Lichtenstein P Antipsychotics, mood stabilisers, and risk of violent crime.Lancet. 2014; 384: 1206-1214Summary Full Text Full Text PDF PubMed Scopus (129) Google Scholar deserve credit for their epidemiological study. However, some issues merit further discussion. Were non-compliant patients excluded from within-individual analyses, thus missing patients who might have had severe psychopathology and, hence, a high risk of violence and crime rates, leading to an inherent selection bias in the study sample?2Hodgins S Riaz M Violence and phases of illness: differential risk and predictors.Eur Psychiatry. 2011; 26: 518-524Summary Full Text Full Text PDF PubMed Scopus (43) Google Scholar Moreover, type and phase of illness were not mentioned, which are both known to affect the risk of violent behaviour and subsequent crime rates.3Bobes J Fillat O Arango C Violence among schizophrenia out-patients compliant with medication: prevalence and associated factors.Acta Psychiatr Scand. 2009; 119: 218-225Crossref PubMed Scopus (41) Google Scholar Sufficient evidence exists to suggest that substance misuse complicates and confounds aggressive behaviour across the range of mental disorders.4Dolan M O'Malley K McGregor K The role of psychopathic traits and substance abuse in predicting violent victimization in patients with schizophrenia spectrum disorders.Personal Ment Health. 2013; 7: 28-38Crossref PubMed Scopus (9) Google Scholar The authors did mention rates of substance misuse, but their possible confounding effects deserve more discussion. The paradoxical issue of benzodiazepine both inducing and reducing agitation in patients was also left unaddressed. In their study, Fazel and colleagues also showed additional benefit of the use of an antipsychotic rather than a mood stabiliser for reduction of violence and crime rates. However, they did not mention whether the patients were on single or multiple antipsychotics, which could affect study outcomes and results interpretation. Finally, their claim of the study's superiority compared with previous works should be taken with caution. We feel that the authors could have substantially increased the validity of their findings by asking a few questions from patients or their immediate caregivers related to compliance, domestic violence, effect of hospitalisation, and substance misuse. We declare no competing interests. Antipsychotics, mood stabilisers, and risk of violent crimeIn 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. Full-Text PDF Open AccessPsychotropics and risk of violent crime – Authors' replyWe are grateful to Michael Dettling and Ion Anghelescu for raising clinically relevant questions about the drugs that we investigated in our study.1 We selected antipsychotics and mood stabilisers, but not hypnotics (including benzodiazepines) because we focused on long-term outcomes associated with widely prescribed psychiatric drugs, whereas hypnotics are typically prescribed for short periods. We studied antipsychotics and mood stabilisers together for the primary analyses because their coadministration is common, at least in schizophrenia-spectrum disorders. Full-Text PDF" @default.
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• W2081310080 title "Psychotropics and risk of violent crime" @default.
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