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Associations between antipsychotics and risk of violent crimes and suicidal behaviour in personality disorder

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Title: Associations between antipsychotics and risk of violent crimes and suicidal behaviour in personality disorder
Authors: Herttua, K
Crawford, M
Paljarvi, T
Fazel, S
Item 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.
Issue Date: 25-Oct-2022
Date of Acceptance: 29-Sep-2022
URI: http://hdl.handle.net/10044/1/100337
DOI: 10.1136/ebmental-2022-300493
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/.
Publication Status: Published
Conference Place: England
Online Publication Date: 2022-10-25
Appears in Collections:Faculty of Medicine
Department of Brain Sciences

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