Associations between antipsychotics and risk of violent crimes and suicidal behaviour in personality disorder
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Published version
Author(s)
Herttua, Kimmo
Crawford, Mike
Paljarvi, Tapio
Fazel, Seena
Type
Journal Article
Abstract
BACKGROUND: Despite uncertain benefits, people with personality disorder are commonly treated with antipsychotic medication. OBJECTIVE: To investigate the association between antipsychotics and violent crimes and suicidal behaviour in individuals with personality disorder. METHODS: We used nationwide Danish registries to identify all individuals with diagnosed personality disorder aged 18-64 years during 2007 to 2016. Antipsychotics were recorded in dispensed prescriptions, and individuals were followed up for police-recorded suspicions for violent crimes and healthcare presentations of suicidal behaviour. We applied a within-individual design where outcome rates for individuals with personality disorder during medicated periods were compared with rates during non-medicated periods. FINDINGS: The cohort included 166 328 people with diagnosed personality disorder, of whom 79 253 were prescribed antipsychotics, presented at least one outcome and were thus included in the within-individual analyses. Compared with periods when individuals were not on antipsychotic medication, violent crime suspicions were 40% lower (incident rate ratio (IRR) 0.60, 95% CI 0.55 to 0.63) in men and 10% lower (IRR 0.90, 95% CI 0.79 to 1.01) in women, while rates of suicidal behaviour were 32% lower both in men (IRR 0.68, 95% CI 0.66 to 0.71) and in women (IRR 0.68, 95% CI 0.65 to 0.70). In subgroup analyses, the magnitude of the association varied across specific personality disorders for criminal outcomes but less for suicidal behaviour, with largest association in dissocial personality disorder for violent criminality (IRR 0.53, 95% CI 0.47 to 0.59). CONCLUSIONS: Treatment with antipsychotics was associated with reduced risks for violent crime suspicions and suicidal behaviour among individuals with personality disorder. CLINICAL IMPLICATIONS: Potential effects of antipsychotics on suicidal behaviour and violence should be taken into account when considering treatment options for people with personality disorders.
Date Issued
2022-10-25
Date Acceptance
2022-09-29
Citation
Evidence-Based Mental Health, 2022, 25 (e1), pp.e58-e64
ISSN
1362-0347
Publisher
BMJ Publishing Group
Start Page
e58
End Page
e64
Journal / Book Title
Evidence-Based Mental Health
Volume
25
Issue
e1
Copyright Statement
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/36283800
PII: ebmental-2022-300493
Subjects
Adult psychiatry
Forensic psychiatry
Personality disorders
Suicide & self-harm
Publication Status
Published
Coverage Spatial
England
Date Publish Online
2022-10-25