Dr. Ghossoub is Assistant Professor of Clinical Psychiatry, Department of Psychiatry, American University of Beirut, Beirut, Lebanon. Dr. Salem is a general psychiatry resident, Department of Psychiatry and Behavioral Neurosciences, Saint Louis University, Saint Louis, MO. Dr. Minchin is Psychiatrist, Metropolitan Saint Louis Psychiatric Center, Saint Louis, MO. Dr. Hayreh is a psychiatrist in private practice, Saint Louis, MO. Dr. Newman is Professor of Psychiatry, Department of Psychiatry and Behavioral Neurosciences, Saint Louis University, Saint Louis, MO.
J Am Acad Psychiatry Law. 2021 Mar;49(1):42-48. doi: 10.29158/JAAPL.200051-20. Epub 2020 Nov 27.
Most defendants found incompetent to stand trial have psychotic illnesses. Clozapine has been shown to be superior to other antipsychotic medications in treatment-resistant schizophrenia. It is vastly underutilized, however, including in forensic settings. To our knowledge, there have been no studies exploring the risks and benefits of clozapine for incompetent to stand trial defendants with severe mental illness. We sought to explore the characteristics of patients who were prescribed clozapine in a retrospective sample of defendants deemed incompetent to stand trial with diagnoses of psychotic and bipolar disorders. We found that 25 of 240 defendants (10%) were prescribed clozapine, with 15 (60%) eventually being discharged on it. Of those 15, 8 defendants were successfully restored to competency to stand trial. The restoration rate in the clozapine group was much lower than in the non-clozapine group (32% versus 87%). Our results emphasize the need for prospective comparative studies assessing the efficacy and tolerability of clozapine and other antipsychotic medications related to restoration of competency to stand trial.
大多数被判定无能力接受审判的被告都患有精神病。氯氮平已被证明在治疗耐药性精神分裂症方面优于其他抗精神病药物。然而，它的应用非常不足，包括在法医环境中。据我们所知，尚未有研究探讨氯氮平对患有严重精神疾病的无能力接受审判的被告的风险和益处。我们试图探讨在被判定无能力接受审判的患有精神病和双相情感障碍的被告的回顾性样本中，被处方氯氮平的患者的特征。我们发现，240 名被告中有 25 名（10%）被处方氯氮平，其中 15 名（60%）最终以此药出院。在这 15 名患者中，有 8 名成功恢复了接受审判的能力。氯氮平组的恢复率远低于非氯氮平组（32%比 87%）。我们的结果强调需要进行前瞻性比较研究，评估氯氮平及其他与恢复接受审判能力相关的抗精神病药物的疗效和耐受性。
