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2017 ; 7
(5
): 169-179
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Effectiveness of paliperidone depot injection in seriously violent men with
comorbid schizophrenia and dissocial personality disorder in a UK high-security
hospital
#MMPMID28540038
Mortlock AM
; Larkin F
; Ross CC
; Gupta N
; Sengupta S
; Das M
Ther Adv Psychopharmacol
2017[May]; 7
(5
): 169-179
PMID28540038
show ga
BACKGROUND: High-security hospital patients are often complex in presentation and
are characterized by treatment resistance, medication nonadherence and history of
violence. Paliperidone is licensed both as an oral and depot antipsychotic
medication in the treatment of schizophrenia. Clinical trials have shown that
paliperidone depot is well tolerated with similar efficacy to risperidone depot
but with additional practical advantages. Whilst data exist for the effectiveness
of paliperidone palmitate (PP), there are no studies involving patients in
forensic settings or those with comorbid personality disorder. Our aim was to
evaluate the effectiveness of PP on violence, aggression and personality disorder
symptoms. METHODS: This project was a retrospective service evaluation involving
11 patients, carried out in a high-security hospital. A combination of patient
records and interviews with the treating consultant psychiatrist were used to
ascertain a Clinical Global Impression (CGI) score, the effect of PP on specific
personality disorder symptom domains (cognitive-perceptual, impulsive-behavioural
dyscontrol and affective dysregulation) and incidents of violence and aggression.
Engagement with occupational and psychological therapies was also evaluated.
Metabolic parameters were reviewed. RESULTS: A total of 6 out of 11 patients
continued on PP, most of whom had schizophrenia and dissocial personality
disorder with histories of violence. All showed improvement in the CGI score with
associated benefits in the three personality symptom domains. Overall, two
patients demonstrated a reduction in the risk of violence. There was improvement
in engagement with occupational therapy and psychological work. No significant
effects on metabolic parameters were noted although hyperprolactinaemia, albeit
asymptomatic, was consistently recorded. CONCLUSIONS: This pragmatic service
evaluation of a small but complex patient group demonstrated, for the first time,
that PP was effective in reducing violence as well as improving personality
pathology across all dimensions: a finding which could have significant
implications for management of such high-security patients.