Psychopharmacologic treatment of in-patients with schizophrenia: comparing forensic and general psychiatry

Patients with schizophrenia constitute a substantial proportion of patients hospitalized in forensic psychiatry. Antipsychotic medication is an essential part of evidence-based treatment and can significantly improve both the medical and legal prognosis. In this study, we compared psychopathological features, psychopharmacological treatment, and the neurologic and metabolic side effects of treatment in demographically comparable in-patients with schizophrenia being treated in either forensic or general psychiatry. Megalomanic ideations, animosity, affect flattening, weak will, social passivity, apathy, uncooperative behavior, and poor impulse control were more pronounced in the forensic psychiatry sample. Nevertheless, patients in the forensic setting were prescribed less antipsychotic medication than the general psychiatry patients. Polypharmacy was pronounced in both samples. There were no significant differences in prescription rates of depot antipsychotics, movement disorders, or metabolic parameters. Our preliminary findings suggest a number of differences in the symptomatology and antipsychotic drug treatment of forensic and general adult psychiatry patients with schizophrenia. These differences deserve reexamination with more sophisticated designs.