BACKGROUND This prospective cohort study aimed at evaluating patterns of polypharmacy, aggressive and violent behaviour during a 1-year follow-up (FU) in patients with severe mental disorders. METHODS 340 patients (125 inpatients from residential facilities and 215 outpatients) were evaluated at baseline with the Structured Clinical Interview for DSM-IV Axis I and II, Brief Psychiatric Rating Scale, Specific Levels of Functioning scale, Brown-Goodwin Lifetime History of Aggression, Buss-Durkee Hostility Inventory, Barratt Impulsiveness Scale, and State-Trait Anger Expression Inventory-2. Aggressive behaviour was rated every fifteen days with the Modified Overt Aggression Scale (MOAS); treatment compliance with the Medication Adherence Rating Scale (MARS). RESULTS The whole sample was prescribed mainly antipsychotics (APs) with high levels of polypharmacy. Clozapine prescription and higher compliance were associated with lower levels of aggressive and violent behaviour. Patients with a history of violence who took clozapine were prescribed the highest number of drugs. The patterns of cumulative MOAS mean scores of patients taking clozapine (N = 46), other APs (N = 257), and no APs (N = 37) were significantly different (p = .001). Patients taking clozapine showed a time trend at 1-year FU (24 evaluations) indicating a significantly lower level of aggressive behaviour. Patient higher compliance was also associated with lower MOAS ratings during the 1-year FU. CONCLUSION Both inpatients and outpatients showed high levels of polypharmacy. Clozapine prescription was associated with lower MOAS ratings compared with any other APs or other psychotropic drugs. Higher compliance was associated with lower levels of aggressive and violent behaviour.

中文翻译：

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精神药物的处方模式和暴力行为的风险：意大利的一项前瞻性、多中心研究。

背景 这项前瞻性队列研究旨在评估严重精神障碍患者在 1 年随访 (FU) 期间的多种用药、攻击性和暴力行为模式。方法 340 名患者（125 名住院患者和 215 名门诊患者）在基线时使用 DSM-IV 轴 I 和 II 的结构化临床访谈、简要精神病评定量表、特定功能水平量表、Brown-Goodwin 攻击史、 Buss-Durkee 敌意量表、Barratt 冲动量表和状态-特质愤怒表达量表-2。攻击行为每十五天用改良的公开攻击量表 (MOAS) 进行评估；药物依从性评定量表 (MARS) 的治疗依从性。结果 整个样本的处方主要是抗精神病药 (APs)，具有高水平的多药性。氯氮平处方和较高的依从性与较低水平的攻击性和暴力行为相关。服用氯氮平的有暴力史的患者开出的药物数量最多。服用氯氮平 (N = 46)、其他 AP (N = 257) 和无 AP (N = 37) 的患者的累积 MOAS 平均评分模式有显着差异 (p = .001)。服用氯氮平的患者在 1 年 FU（24 次评估）时显示出时间趋势，表明攻击行为水平显着降低。患者较高的依从性也与 1 年 FU 期间较低的 MOAS 评分相关。结论 住院病人和门诊病人都表现出高水平的多重用药。与任何其他 AP 或其他精神药物相比，氯氮平处方与较低的 MOAS 评分相关。较高的依从性与较低水平的攻击性和暴力行为相关。