Lemons Amber, Iuppa Courtney A, Kriz Carrie R, Diefenderfer Lauren A, Nelson Leigh Anne, Lang Shelby E, Elliott Ellie S R, Moon Joseph, Sommi Roger W
Psychiatric Pharmacy Resident, Missouri Department of Mental Health, Center for Behavioral Medicine, Kansas City, Missouri; Clinical Psychiatric Pharmacist, Denver Health Medical Center, Denver, Colorado.
Clinical Research Coordinator, University of Missouri-Kansas City School of Pharmacy, Kansas City, Missouri.
Ment Health Clin. 2022 Jun 10;12(3):175-180. doi: 10.9740/mhc.2022.06.175. eCollection 2022 Jun.
A defendant who is deemed incompetent to stand trial may go through competency restoration consisting of mental health treatment and legal education. Antipsychotics are often used in treatment; however, there is little data examining their role.
This retrospective study included subjects opined competent to stand trial from July 2016 to February 2020 and prescribed an antipsychotic. The primary outcome was difference in time to competency between antipsychotics. Secondary outcomes included difference in time to competency between groups of antipsychotics, difference in length of stay after opined competent based on medication availability in jail, individual antipsychotics, and formulations.
There were 117 subjects included for analysis. There were no differences in time to competency between individual antipsychotics, first- and second-generation antipsychotics, or formulations. Length of stay after opined competent was significantly longer for subjects who were prescribed a long-acting injectable antipsychotic (103 days vs 56 days), who were not able to receive their antipsychotic in jail (104 days vs 54 days), or who were prescribed any formulation of paliperidone compared with olanzapine (88 days vs 35 days).
Since there were no differences in time to competency, patient-specific factors should be used to choose an agent for competency restoration. Length of stay differences are likely related to the antipsychotic access differences between jails and state psychiatric facilities. Therefore, policies related to antipsychotic access should better align between state psychiatric facilities and jails to improve the capacity of the system and provide better care.
被认为无能力接受审判的被告可能要经历由心理健康治疗和法律教育组成的能力恢复过程。抗精神病药物常用于治疗；然而，几乎没有数据研究它们的作用。
这项回顾性研究纳入了2016年7月至2020年2月期间被判定有能力接受审判并被开具抗精神病药物的受试者。主要结局是不同抗精神病药物在恢复能力时间上的差异。次要结局包括不同组抗精神病药物在恢复能力时间上的差异、根据监狱中药物供应情况、个体抗精神病药物和剂型，在被判定有能力之后的住院时间差异。
共有117名受试者纳入分析。个体抗精神病药物、第一代和第二代抗精神病药物或剂型在恢复能力时间上没有差异。对于被开具长效注射用抗精神病药物的受试者（103天对56天）、在监狱中无法获得其抗精神病药物的受试者（104天对54天），或与接受奥氮平相比接受任何剂型帕利哌酮的受试者（88天对35天），在被判定有能力之后的住院时间显著更长。
由于在恢复能力时间上没有差异，应根据患者的具体因素来选择用于能力恢复的药物。住院时间差异可能与监狱和州立精神病设施之间抗精神病药物的获取差异有关。因此，州立精神病设施和监狱之间与抗精神病药物获取相关的政策应更好地协调，以提高系统的能力并提供更好的护理。
