Does clozapine promote employability and reduce offending among mentally disordered offenders?

OBJECTIVE: To compare employment pay, count of infractions, and clinical symptoms in psychiatric inmates treated with clozapine or other antipsychotics after 6 months of treatment. METHODS: Clinical charts and institutional offence records of psychiatric inmates (n = 98), comprised of those on clozapine (n = 65) and on other antipsychotics (n = 33), were reviewed at baseline and after 6 months of treatment. The outcome measures used were Brief Psychiatric Rating Scale (BPRS) scores, employment pay, medication compliance, and the frequency of institutional offences. A binary logistic regression model was used to analyze a categorical change in pay variable, while a negative binomial model was used to analyze the frequency of infractions. RESULTS: Treatment with clozapine was associated with greater odds of a pay increase (OR = 3.13; 95% CI 1.3 to 7.53, P = 0.01). However, patients on other antipsychotics had a more favourable improvement in BPRS (F = 5.44, df = 1,57, P = 0.02). Patients on other antipsychotics also had a higher count of posttreatment offences (Incidence Rate Ratio = 2.22; 95% CI 1.11 to 4.41, P = 0.02). CONCLUSION: Clozapine probably has a favourable effect on inmate behaviour and institutional adjustment. This effect can last up to 36 months after the initial dose.