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

Abstract

OBJECTIVEWe 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’.METHODThe 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.ResultsTwenty-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.CONCLUSIONSSuch 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.