Medications cut violence among mentally ill
Medications Cut Violence Among Mentally Ill in Study
Report Comes Amid Concerns Sparked by High-Profile Mass Shootings
May 7, 2014 7:05 p.m. ET
Mentally ill people are substantially less likely to commit a violent crime if they are taking psychiatric medication, according to a large new study of the mentally ill in Sweden.
The study, published in the journal The Lancet, comes amid persistent concern about the connection between violence and mental illness, fueled by high-profile mass shootings and crimes committed by people diagnosed with psychiatric disorders. Many mental-health experts say the connection between the two is overblown in the public mind.
Previous evidence suggests that people with severe mental illnesses do have an elevated risk of violent behavior, compared with the general population, particularly when they are untreated or are engaged in substance abuse. But there has been limited research on the question of whether taking psychiatric medication helps to reduce violence. At the same time, some mental-health experts express concerns about the side effects of heavy-duty psychiatric medications, relative to their benefit.
Antipsychotic drugs, which include Clozaril, Risperdal and Zyprexa, commonly sold as generics, are used to treat schizophrenia and other severe mental illness in which individuals lose touch with reality. Side effects include weight gain, sedation and sexual side effects, which lead many patients to stop taking the drugs. Mood stabilizers, such as the drug known commonly as Depakote, are prescribed for those with conditions including bipolar disorder. The new study suggests that such medicines appear to have the benefit of damping violent behavior.
"It's another piece in the jigsaw puzzle that helps you think about the risks and benefits of putting them and keeping them on medication," said Seena Fazel, a senior research fellow in clinical science at Oxford University and the first author on the study.
Only a minority of patients perpetrate crimes, said Dr. Fazel. "But even in this minority, it may be to a large extent a modifiable risk."
The study was funded by the Wellcome Trust, a private U.K. foundation, and several grants from the Swedish government. Dr. Fazel said he has no financial ties with drug makers.
Researchers from Oxford and the Karolinska Institute in Stockholm used Swedish national registries to examine more than 80,000 people who were prescribed antipsychotics or mood stabilizers from 2006 to 2009, as well as their psychiatric diagnoses and criminal convictions during the same period.
They found a significant 45% drop in convictions for violent crime, such as homicide, assault, robbery or any sexual offense, during periods when the individuals were thought to be taking their medications, based on prescription and dispensing records, regardless of their diagnosis, compared with when they were off meds. Patients diagnosed with bipolar disorder exhibited a 24% decrease in convictions when taking mood stabilizers.
The overall rate of violent-crime convictions for men prescribed the drugs was 6.5% in the period, and 1.4% for women. Previous research has shown a four- to six-fold increase in violence among men with severe mental illness, compared to the general population, according to Dr. Fazel.
The study couldn't determine why the medications reduced violent crimes, but it could be that drugs treated the psychosis itself—by reducing paranoia, for instance—and also provided broader benefits, such as decreasing impulsivity, said Dr. Fazel. In addition, there are questions about whether the results are generalized to other populations outside Sweden. The rates of psychiatric drug use and assaults recorded by the police are similar to those in the U.S., according to Dr. Fazel.
Jeffrey Swanson, a professor of psychiatry and behavioral sciences at Duke University who studies mental health and violence, but wasn't involved with the current research, called the study a "strong analysis" that provides new evidence that the medications commonly used to treat serious mental illnesses can also reduce risk of violent crime in people with these conditions.
However, crime and violence are influenced by many factors, and people with mental illness who perpetrate crimes aren't typical of the mentally ill or criminals, he said. "Violence and mental illness are two important and complicated, but different, public-health problems that intersect on their edges," said Dr. Swanson.
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