ArticleFrontiers in psychiatry2026
Determinants of antipsychotic prescription in women detainees admitted to an acute forensic psychiatric unit.
Article in Frontiers in psychiatry, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Women represent a small proportion of the global prison population but carry a disproportionate burden of mental illness. Evidence indicates high rates of psychotropic medication use among women in prison, often independently of the clinical diagnosis. Antipsychotics, particularly second-generation (SGAs) are widely prescribed in forensic settings. Data focusing on the prescription of these agents to women detainees are still scarce. Objectives: This study aimed to investigate whether socio-demographic, clinical and forensic characteristics determine SGA prescription to women admitted in an acute forensic psychiatric ward located in prison. Methods: We conducted a retrospective study of 166 women admitted between 2014 and 2023 to the sole acute forensic psychiatric unit for detainees in French-speaking Switzerland. Among them, 128 cases received second generation antipsychotic medication during their hospital stay. Sociodemographic data included age, nationality, educational attainment and primary spoken language. Criminological variables included types of offense and detention. Clinical variables included psychiatric outpatient and inpatient history prior to conviction, total number of stays during the study period, main diagnosis, presence of substance use disorder and personality disorders. Psychotropic prescriptions were analyzed with conversion of antipsychotic doses into chlorpromazine equivalents. Regression analyses, including LASSO models were used to identify variables associated with antipsychotic dosage. Results: Psychotropic use was very high with more than two-thirds receiving two or more psychotropic agents. SGAs were prescribed in 77.1% of cases (128 out of 166 cases), while psychotic disorders were diagnosed in only 28.3% indicating frequent off-label use. Regression analyses showed that higher antipsychotic doses were associated with previous psychiatric history, more inpatient stays and court-ordered treatments. Cluster A personality disorders were associated with lower antipsychotic doses. Conclusions: Our findings reveal an extremely high rate of psychotropic use with very frequent off-label prescription for antipsychotics in acute forensic psychiatry wards. Moreover, they show that clinical variables and not demographic and criminological factors determine the use of antipsychotics in this setting.
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