Singh Amarpreet, Delgado Darci, Ventura Maria I, Schwartz Eric, Williams Jared, Meyer Jonathan M
Dr. Singh is Assistant Medical Director, DSH-Napa, Dr. Delgado is Senior Psychologist, Supervisor, Clinical Operations, Dr. Meyer is Psychopharmacology Consultant, and Dr. Schwartz is Psychopharmacology Consultant, California Department of State Hospitals, Patton, CA. Dr. Ventura is Data Analysis Supervisor, and Mr. Williams is Staff Research Associate, Department of Psychiatry and Behavioral Sciences, UC Davis School of Medicine, Davis, CA.
J Am Acad Psychiatry Law. 2022 Sep;50(3):427-433. doi: 10.29158/JAAPL.210123-21. Epub 2022 Jul 7.
Referrals for competency restoration increased in the past decade, with the majority of incompetent to stand trial (IST) patients having schizophrenia; 25 percent of schizophrenia patients are treatment resistant. Clozapine is superior to other antipsychotics for treatment resistance but remains underutilized, particularly in forensic settings. Despite the impact of treatment resistance on the legal system, the literature on clozapine for IST patients is limited to two papers comprising 26 patients. A retrospective chart review was conducted of all IST admissions to a California hospital for 2014 to -2018, examining clinical and forensic outcomes in those newly started on clozapine and discharged. There were 191 new clozapine starts among IST patients, 92.7 percent of whom were diagnosed with schizophrenia or another psychosis. Over 90 percent were discharged on clozapine, and 36.1 percent were discharged on clozapine as trial competent; moreover, this cohort also had the shortest length of stay. This analysis indicates that most IST patients needing clozapine can be successfully treated, with a substantial proportion restored to trial competency. These data and earlier studies reinforce the concept that forensic programs have a medical duty to offer IST patients with severe mental illness a clozapine trial when indications exist for its use.
在过去十年中，恢复行为能力的转介案例有所增加，大多数无能力接受审判（IST）的患者患有精神分裂症；25%的精神分裂症患者对治疗有抵抗性。氯氮平在治疗抵抗方面优于其他抗精神病药物，但使用率仍然较低，尤其是在法医环境中。尽管治疗抵抗对法律系统有影响，但关于氯氮平用于IST患者的文献仅限于两篇包含26名患者的论文。对2014年至2018年加利福尼亚一家医院所有IST入院患者进行了回顾性病历审查，研究了新开始使用氯氮平并出院的患者的临床和法医结果。IST患者中有191例开始使用氯氮平，其中92.7%被诊断患有精神分裂症或其他精神病。超过90%的患者在出院时仍在使用氯氮平，36.1%的患者在出院时被判定有能力接受审判；此外，这一组患者的住院时间也最短。该分析表明，大多数需要氯氮平的IST患者可以得到成功治疗，相当一部分患者恢复了接受审判的能力。这些数据和早期研究强化了这样一个概念，即法医项目在有使用指征时，有医疗责任为患有严重精神疾病的IST患者提供氯氮平试验。
