Mohr Pavel, Knytl Pavel, Voráčková Veronika, Bravermanová Anna, Melicher Tomáš
National Institute of Mental Health, Klecany, Czech Republic.
3rd Faculty of Medicine, Charles University, Prague, Czech Republic.
Int J Clin Pract. 2017 Sep;71(9). doi: 10.1111/ijcp.12997. Epub 2017 Sep 4.
It has been well established that long-term antipsychotic treatment prevents relapse, lowers number of rehospitalisations, and also effectively reduces violent behaviour. Although violent behaviour is not a typical manifestation of schizophrenia or other psychotic disorders, the diagnosis of psychosis increases the overall risk of violence. One of the few modifiable factors of violence risk is adherence with medication. In contrast, non-adherence with drug treatment and subsequent relapse increases risk of violent acts. Non-adherence can be addressed partially by long-acting injectable antipsychotics (LAI). The aim of our review was to examine the role of antipsychotic drugs, especially LAI, in prevention and management of violent behaviour in psychosis.
This is a non-systematic, narrative review of the data from open, naturalistic, retrospective, and population studies, case series, and post hoc analyses of randomised controlled trials. Search of electronic databases (PubMed, Embase) was performed to identify relevant papers.
Nine published papers (3 cross-sectional chart reviews, 4 retrospective studies, 2 prospective, randomised trials) were found. The results indicated positive clinical and antiaggressive effects of LAI in psychotic patients with high risk of violent behaviour.
Reviewed evidence suggests that secured drug treatment with LAI may have clinical benefit in schizophrenia patients with high risk of violent behaviour. LAI significantly reduced the severity of hostility, aggressivity, number of violent incidents, and criminal offences. These findings are supported further by the empirical evidence from clinical practice, high rates of prescribed LAI to schizophrenia patients in high-security and forensic psychiatric facilities.
Available data encourage the use of LAI in forensic psychiatry, especially during court-ordered commitment treatment.
长期使用抗精神病药物治疗可预防复发、减少再住院次数，并有效降低暴力行为，这一点已得到充分证实。尽管暴力行为并非精神分裂症或其他精神障碍的典型表现，但精神病的诊断会增加总体暴力风险。暴力风险中少数可改变的因素之一是药物依从性。相反，不坚持药物治疗及随后的复发会增加暴力行为的风险。长效注射用抗精神病药物（LAI）可部分解决不依从问题。我们综述的目的是研究抗精神病药物，尤其是LAI，在预防和管理精神病患者暴力行为中的作用。
这是一项对来自开放性、自然主义、回顾性和人群研究、病例系列以及随机对照试验事后分析的数据进行的非系统性叙述性综述。通过检索电子数据库（PubMed、Embase）来识别相关论文。
共找到9篇已发表的论文（3篇横断面图表综述、4篇回顾性研究、2篇前瞻性随机试验）。结果表明，LAI对有暴力行为高风险的精神病患者具有积极的临床和抗攻击作用。
综述证据表明，对于有暴力行为高风险的精神分裂症患者，使用LAI确保药物治疗可能具有临床益处。LAI显著降低了敌意、攻击性的严重程度、暴力事件数量和刑事犯罪。临床实践的经验证据进一步支持了这些发现，在高度戒备和法医精神病设施中，精神分裂症患者使用LAI的处方率很高。
现有数据鼓励在法医精神病学中使用LAI，尤其是在法庭命令的强制治疗期间。
