Psychotropic medications reduce further violent crimes in released prisoners

1. In this cohort study, released prisoners in Sweden who received antipsychotics, psychostimulants, and medications used in addictive disorders were less likely to commit a violent crime.

2. The rates of violent crimes were similar between patients who received psychotropic medications and those who were administered prison-based psychological treatments.

Evidence Rating Level: 2 (Good)

Study Rundown: With more than one third of released prisoners in the US and UK committing violent crimes, there remains a significant need for reducing these rates. As mental illness is overrepresented in prison populations, understanding how psychotropic medications may affect re-offense rates in released prisoners is essential. In this prospective cohort study, released prisoners from Sweeden who did and did not receive psychotropic medications were followed closely with rates of violent crimes recorded. For those who took antipsychotics, psychostimulants, or medications used to treat addictive disorders, the rate of violent crimes was reduced. However, those who received antidepressants or anti-epileptics did not show decreased violent crime rates. Similar results were found for those who were treated before and after release. In comparison, those who received psychological treatments showed similar reductions in violent crime rates.

As randomized controlled trials with violent crimes as an endpoint are hard to design and execute, the evidence in this study is very informative for those deciding on policies to reduce the rates of violent crimes after incarceration. However, the Swedish justice and prison system has many differences from other justice systems, especially those in the US, and so the generalizability of these results is hard to determine.

Click to read the study in JAMA

Relevant Reading: Antipsychotics, mood stabilisers, and risk of violent crime

In-Depth [cohort study]: A total of 22,275 prisoners released from Swedish prisons between 2005 and 2010 were tracked for a median of 4.6 years after release. Among all included in the study, 9915 received psychotropic medications and 5561 completed psychological programs. During follow-up, 4031 (18.1%) people were reconvicted for 5653 violent crimes. The between-individual analyses showed a reduction in violent crimes for prisoners who received antipsychotics (reduction of 21.7 violent crimes per 1000 person years; 95%CI 3.7 to 35.9). Similarly, those taking psychostimulants saw a reduction of 33.9 violent crimes per 1000 person years (95%CI 13.5 to 39.7) and those taking medications for addictive disorders saw a reduction of 27.5 violent crimes per 1000 person years (95%CI 7.0 to 41.6). Those who received antidepressants, antiepileptics, and adrenergic inhalants (negative control) did not show any differences from the un-medicated population. The within-individual analyses showed similar results, with 39.7 (95%CI 11.3 to 57.7) fewer violent offenses in total for antipsychotics, 42.8 for psychostimulants (95%CI2.2 to 67.6), and 36.4 (95%CI 2.1 to 54.0) for medications for addictive disorders. For psychological programs designed to prevent crime generally, the reduction in violent offenses was similar at 11.6 less violent crimes per 1000 person years (95%CI 5.1 to 17.1), and programs designed to treat substance abuse also reduced violent offenses by 23.2 (95%CI 10.3 to 34.1). Surprisingly, programs designed to reduce violent reoffending showed no differences in violent crime offenses.

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