Post-discharge pharmacological treatment discontinuation of forensic psychiatric patients in Sweden.

Introduction: Most forensic psychiatric patients have chronic psychiatric disorders that require long-term pharmacological treatment even after discharge from care. However, the prevalence and correlates of post-discharge medication discontinuation in this patient group remain unclear. Objective: The aim of this study was to investigate the prevalence and correlates of post-discharge discontinuation of pharmacological treatment in forensic psychiatric patients in Sweden. Methods: Data on individuals discharged from forensic psychiatric care between 2009 and 2018 (n = 1,142) with ongoing pharmacological treatment at the time of discharge (n = 856) were identified from the Swedish National Forensic Psychiatric Register. Cox regression models were used to estimate the association between patient characteristics and medication discontinuation. Results: Of the 856 individuals with pharmacological treatment at discharge, 488 (57%) discontinued treatment within 2 years of discharge. Factors associated with an increased risk of treatment discontinuation varied between different types of psychotropic medications: the most important correlate was comorbidity between psychosis and personality disorder. Higher age at discharge, longer length of stay, having a history of several psychiatric care episodes, having a trustee, having a limited guardian, and a residing in a supported living accommodation at the time of discharge were associated with a decreased rate of medication discontinuation. This applied for antipsychotics, antidepressants, antiepileptics, and any psychotropic medication, but not for psychostimulants or drugs used in addictive disorders. Conclusion: For many former forensic psychiatric patients, there are situational factors associated with medication discontinuation. This insight holds significance for professionals who are involved in pre-discharge planning within forensic psychiatric care and those who interact with this cohort of former patients post-discharge.

What happens after forensic psychiatric care? A latent class analysis of dimensions of welfare for former forensic psychiatric patients.

BACKGROUND: Mentally disordered offenders are a heterogenous group regarding psychopathology as well as background factors, which makes it likely that more than one stereotypical life situation will apply to all forensic psychiatric patients following discharge. Knowledge about typical life situations would be valuable for optimising support for improving the overall life situation of these individuals. This paper investigates life situations from the perspective of level of living research and resources in terms of different welfare dimensions. METHODS: Included were all all individuals (n = 1146) who had been discharged from forensic psychiatric care in Sweden during 2009-2018 and were included in the Swedish National Forensic Psychiatric Register. Follow-up time varied from 4 to 3644 days, (m = 1697, Md = 1685). Register data from several different registers was combined. Data was analysed using latent class analysis, and multinominal logistic regression analysis investigated what background factors were associated with class membership. RESULTS: The results show that there are four subgroups of post-discharge life situations: the high support group, the general psychiatric needs group, the working group, and the family group. The high support group was the largest, representing 54% of the entire sample. There are background factors associated with group membership, including both age at discharge, length of stay in forensic psychiatric care and pre-index crime historical factors. CONCLUSIONS: This study contributes to the understanding of the post-discharge lives of former forensic psychiatric patients and shows that for several subgroups, negative outcomes are rare. Knowledge about these subgroups could be drawn upon to make informed decisions about in- and outpatient forensic psychiatric care, discharge from forensic psychiatric services, and what support is offered to former forensic psychiatric patients.

The reconvictions of mentally disordered offenders-how, when, and where?

BACKGROUND: Little is known about the recidivism of mentally disordered offenders after discharge from forensic psychiatric services. This is problematic because such knowledge could (i) help professionals who encounter this group to better plan interventions to prevent recidivism, (ii) clarify the rates of recidivism post-discharge from forensic psychiatric care and (iii) further develop instruments for specific risk assessment. The aim of this study was to investigate the new crimes of mentally disordered offenders who had been reconvicted after discharge from forensic psychiatric care. METHODS: Included in this study were all individuals (n = 1142) who had been discharged from forensic psychiatric care in Sweden during 2009-2018, were included in the Swedish National Forensic Psychiatric Register, and had been reconvicted in a criminal court within the follow-up period of 2009-2018 (n = 157, 14% of the population). The follow-up times of the discharged patients within the period varied from 4 to 3644 days, (m = 1697, Md = 1685). Retrospective registry data along with coded data from criminal court judgments (n = 210) were used to create a database. Kaplan-Meier survival analysis and descriptive statistical analysis was performed. RESULTS: 75% of included individuals were reconvicted for at least one violent crime, but only 9 individuals were reconvicted for a serious violent crime, which can be compared to the 44 individuals with serious violent index crimes. The most common crime was "Other violent". The most common sentence was probation. The offender's most common relationship to the victim was having no known relationship, followed by the victim being a person of authority. The most common circumstance of the crime leading to the reconviction was that it occurred without apparent provocation; other common circumstances were related to the exercise of public authority. The most common crime scene was a public place. CONCLUSIONS: Even though the reconvictions of this group included many violent crimes, there were very few serious violent crimes. The findings that the victims of the crimes of mentally disordered offenders are most commonly either unknown to the perpetrator or persons of authority, and that the crimes are often perpetrated without apparent provocation or reason, are important information for all professionals who encounter this group and should be taken into consideration to assess risk more accurately.