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Combining depot antipsychotic medications with novel antipsychotics in forensic patients: a practice in search of a principle

East Wing, Manly Hospital, Darley Rd, NSW 2066, Australia

Olav B. Nielssen, Consultant Psychiatrist

Corrections Health Service, Matraville, Australia

Declaration of interest

Both J. B. and O. N. were employees of Long Bay Prison Hospital (Corrections Health Service) at the time the research was conducted. O. N. has received payment for lectures sponsored by GlaxoSmithKline and Janssen Cilag.

OBJECTIVE

We observed a pattern of combining depot antipsychotic medication with the newer ‘atypical’ antipsychotics in forensic patients. We aimed to determine the prevalence and rationale for such ‘combination therapy’.

METHOD

The medical records of forensic patients in 3 forensic hospitals in New South Wales, Australia, were reviewed and the responsible psychiatrists asked to explain the rationale for treatment of those patients on combination therapy.

RESULTS

Twenty-two per cent of the forensic patient population were receiving combination therapy. The reasons given for combination therapy were the presence of treatment-resistant illness, to ensure adherence to at least part of the treatment and to assist transfer to lower security units.

CONCLUSIONS

Such a high prevalence of a practice that is discouraged and without theoretical justification is a cause for concern. It appeared to reflect the practical difficulties of managing forensic patients.

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