{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T20:28:02Z","timestamp":1790886482117,"version":"4.1.0"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,2,10]],"date-time":"2022-02-10T00:00:00Z","timestamp":1644451200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychol."],"abstract":"<jats:p>Few data exist regarding treatment with antipsychotics in forensic psychiatric patient populations with high social dangerousness. We performed a secondary analysis of 681 patients treated with at least one antipsychotic, extracted from a 1-year observational retrospective study, conducted on 730 patients treated in the Italian Residencies for Execution of Security Measures (REMS) (96.4% of the REMS population). We aimed at investigating antipsychotic polypharmacy (prescription of two or more concomitant antipsychotics) and high dose\/very high-dose antipsychotics, as well as the possible factors associated with such therapeutic regimens. High dose\/very high-dose antipsychotics were defined as a prescribed daily dose to WHO-defined daily dose ratio greater than 1.5 or 3.0, respectively. Binary logistic regression analysis was used in three models to test possible predictors of antipsychotic polypharmacy, high-dose antipsychotics, and very high-dose antipsychotic prescription. Antipsychotic polypharmacy resulted in <jats:italic>n<\/jats:italic> = 308 (45.2%) of the patients, <jats:italic>n<\/jats:italic> = 346 (50.8%) received high-dose antipsychotics, and <jats:italic>n<\/jats:italic> = 96 (14.1%) very high-dose antipsychotics. The multivariate analysis disclosed an association between antipsychotic polypharmacy and male gender (odds ratio (OR): 2.75 and 95% CI: 1.34\u20135.65), long-acting injectable (LAI) antipsychotic prescription (OR: 2.62 and 95% CI: 1.84\u20133.74), and aggressive behavior in REMS (OR: 1.63 and 95% CI: 1.13\u20132.36). High-dose antipsychotics were also associated with male gender (OR: 2.01 and 95% CI: 1.02\u20133.95), LAI antipsychotic prescription (OR: 2.78 and 95% CI: 1.95\u20133.97), and aggressive behavior in REMS (OR: 1.63 and 95% CI: 1.12\u20132.36). The use of antipsychotic polypharmacy and high-dose antipsychotics is frequent in the REMS population. These results might depend on regulatory and organizational aspects of the REMS system, including variability in structures, lack of a common model of care, and lack of stratified therapeutic security.<\/jats:p>","DOI":"10.3389\/fpsyg.2022.722985","type":"journal-article","created":{"date-parts":[[2022,2,10]],"date-time":"2022-02-10T07:02:52Z","timestamp":1644476572000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":21,"title":["Antipsychotic Polypharmacy and High-Dose Antipsychotic Regimens in the Residential Italian Forensic Psychiatric Population (REMS)"],"prefix":"10.3389","volume":"13","author":[{"given":"Gabriele","family":"Mandarelli","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felice","family":"Carabellese","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guido","family":"Di Sciascio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Catanesi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,2,10]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"45","DOI":"10.4103\/japtr.JAPTR_110_20","article-title":"Assessment of potential drug interactions among psychiatric inpatients receiving antipsychotic therapy of a secondary care hospital, United Arab Emirates.","volume":"12","author":"Aburamadan","year":"2021","journal-title":"J. Adv. Pharm. Technol. Res."},{"key":"B2","doi-asserted-by":"publisher","first-page":"445","DOI":"10.1192\/bjp.bp.114.153817","article-title":"Closing forensic psychiatric hospitals in Italy: a new revolution begins?","volume":"206","author":"Barbui","year":"2015","journal-title":"Br. J. Psychiatry"},{"key":"B3","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1016\/j.schres.2020.08.026","article-title":"Mortality risk from long-term treatment with antipsychotic polypharmacy vs monotherapy among adults with serious mental illness: a systematic review and meta-analysis of observational studies.","volume":"223","author":"Buhagiar","year":"2020","journal-title":"Schizophr. Res."},{"key":"B4","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1046\/j.1440-1665.2000.00264.x","article-title":"Patterns of use of antipsychotic medication in a regional community mental health service.","volume":"8","author":"Callaly","year":"2000","journal-title":"Australas. Psychiatry"},{"key":"B5","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1016\/j.psychres.2016.09.035","article-title":"Patterns of antipsychotics\u2019 prescription in Portuguese acute psychiatric wards: a cross-sectional study.","volume":"246","author":"Campos Mendes","year":"2016","journal-title":"Psychiatry Res."},{"key":"B6","doi-asserted-by":"publisher","first-page":"444","DOI":"10.1002\/bsl.2234","article-title":"Closing Italian forensic psychiatry hospitals in favor of treating insanity acquittees in the community.","volume":"34","author":"Carabellese","year":"2016","journal-title":"Behav. Sci. Law"},{"key":"B7","first-page":"91","article-title":"Is involuntary psychiatric hospitalization a measure for preventing the risk of patients\u2019 violent behavior to self or others? A consideration of the Italian regulation.","volume":"23","author":"Carabellese","year":"2017","journal-title":"J. Psychopathol."},{"key":"B8","first-page":"207","article-title":"Informed consent in forensic treatment. Lights, shadows, assumptions, perspectives.","volume":"12","author":"Carabellese","year":"2018","journal-title":"Rass. Ital. di Criminol."},{"key":"B9","doi-asserted-by":"publisher","first-page":"182","DOI":"10.7347\/RIC-2017-p182","article-title":"Responsibility of psychiatrists at the time of REMS.","volume":"11","author":"Catanesi","year":"2017","journal-title":"Rass. Ital. di Criminol."},{"key":"B10","doi-asserted-by":"publisher","first-page":"7","DOI":"10.7347\/RIC-NS2019-p07","article-title":"The new Italian residential forensic psychiatric system (REMS). A one-year population study.","volume":"13","author":"Catanesi","year":"2019","journal-title":"Rass. Ital. di Criminol."},{"key":"B11","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1177\/2045125314540298","article-title":"Factors associated with non evidence-based prescribing of antipsychotics.","volume":"4","author":"Connolly","year":"2014","journal-title":"Ther. Adv. Psychopharmacol."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1159","DOI":"10.1093\/schbul\/sbs097","article-title":"Guideline-concordant antipsychotic use and mortality in schizophrenia.","volume":"39","author":"Cullen","year":"2013","journal-title":"Schizophr. Bull."},{"key":"B13","doi-asserted-by":"publisher","first-page":"635","DOI":"10.1080\/14656566.2020.1847274","article-title":"Does antipsychotic combination therapy reduce the risk of hospitalization in schizophrenia?","volume":"22","author":"Faden","year":"2021","journal-title":"Expert Opin. Pharmacother."},{"key":"B14","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1080\/09540261.2020.1772581","article-title":"Involuntary psychiatric hospitalization in Italy: critical issues in the application of the provisions of law.","volume":"33","author":"Ferracuti","year":"2020","journal-title":"Int. Rev. Psychiatry"},{"key":"B15","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1111\/ijcp.12276","article-title":"A retrospective study of psychotropic drug use among individuals with mental illness issued a community treatment order.","volume":"68","author":"Gisev","year":"","journal-title":"Int. J. Clin. Pract."},{"key":"B16","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1097\/JCP.0000000000000098","article-title":"Factors associated with antipsychotic polypharmacy and high-dose antipsychotics among individuals receiving compulsory treatment in the community.","volume":"34","author":"Gisev","year":"","journal-title":"J. Clin. Psychopharmacol."},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1177\/2045125320957119","article-title":"Check the effects: systematic assessment of antipsychotic side-effects in an inpatient cohort.","volume":"10","author":"Hynes","year":"2020","journal-title":"Ther. Adv. Psychopharmacol."},{"key":"B18","doi-asserted-by":"publisher","first-page":"546","DOI":"10.1177\/1039856214546672","article-title":"Prevalence and nature of antipsychotic polypharmacy among inpatients with schizophrenia spectrum disorders at an Australian mental health service.","volume":"22","author":"John","year":"2014","journal-title":"Australas. Psychiatry"},{"key":"B19","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1192\/bja.2021.34","article-title":"Models of care in forensic psychiatry.","volume":"28","author":"Kennedy","year":"2021","journal-title":"BJPsych Adv."},{"key":"B20","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1192\/pb.26.11.411","article-title":"The influence of patient variables on polypharmacy and combined high dose of antipsychotic drugs prescribed for in-patients.","volume":"26","author":"Lelliott","year":"2002","journal-title":"Psychiatr. Bull."},{"key":"B21","doi-asserted-by":"publisher","first-page":"S90","DOI":"10.1093\/schbul\/sbv167","article-title":"Dose equivalents for antipsychotic drugs: the DDD method.","author":"Leucht","year":"2016","journal-title":"Schizophr. Bull."},{"key":"B22","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1097\/JCP.0000000000001355","article-title":"The additional effect of individualized prescriber-focused feedback on general guideline instruction in reducing antipsychotic polypharmacy in inpatients.","volume":"41","author":"Lochmann van Bennekom","year":"2021","journal-title":"J. Clin. Psychopharmacol."},{"key":"B23","doi-asserted-by":"publisher","first-page":"492","DOI":"10.1017\/S2045796017000063","article-title":"Treatment decision-making capacity in non-consensual psychiatric treatment: a multicentre study.","volume":"27","author":"Mandarelli","year":"2018","journal-title":"Epidemiol. Psychiatr. Sci."},{"key":"B24","doi-asserted-by":"publisher","first-page":"1002","DOI":"10.1111\/1556-4029.12420","article-title":"Mental capacity in patients involuntarily or voluntarily receiving psychiatric treatment for an acute mental disorder.","volume":"59","author":"Mandarelli","year":"2014","journal-title":"J. Forensic Sci."},{"key":"B25","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1002\/mpr.22","article-title":"Italian validation of MOAS and NOSIE: a useful package for psychiatric assessment and monitoring of aggressive behaviours.","volume":"14","author":"Margari","year":"2005","journal-title":"Int. J. Methods Psychiatr. Res."},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1186\/s12888-017-1295-1","article-title":"Antipsychotic prescribing for vulnerable populations: a clinical audit at an acute Australian mental health unit at two-time points.","volume":"17","author":"McMillan","year":"2017","journal-title":"BMC Psychiatry"},{"key":"B27","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1111\/acps.13066","article-title":"Antipsychotic use and risk of life-threatening medical events: umbrella review of observational studies.","volume":"140","author":"Papola","year":"2019","journal-title":"Acta Psychiatr. Scand."},{"key":"B28","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1177\/0004867413488221","article-title":"Antipsychotic polypharmacy and high-dose prescription in schizophrenia: a 5-year comparison.","volume":"48","author":"Roh","year":"2014","journal-title":"Aust. N. Z. J. Psychiatry"},{"key":"B29","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1016\/j.euroneuro.2020.06.007","article-title":"Impact of antipsychotic polypharmacy on nonadherence of oral antipsychotic drugs \u2013 A study based on blood sample analyses from 24,239 patients.","volume":"37","author":"Smith","year":"2020","journal-title":"Eur. Neuropsychopharmacol. J. Eur. Coll. Neuropsychopharmacol."},{"key":"B30","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1192\/pb.bp.108.020776","article-title":"Polypharmacy and high-dose antipsychotic regimes in the community.","volume":"34","author":"Tungaraza","year":"2010","journal-title":"Psychiatrist"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1186\/s12888-020-02661-6","article-title":"Is higher psychotropic medication burden associated with involuntary treatment under the Mental Health Act? A four-year Australian cohort study.","volume":"20","author":"Wheeler","year":"2020","journal-title":"BMC Psychiatry"},{"key":"B32","year":"2021","journal-title":"ATC\/DDD Index."}],"container-title":["Frontiers in Psychology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2022.722985\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,2,10]],"date-time":"2022-02-10T07:02:58Z","timestamp":1644476578000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2022.722985\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,10]]},"references-count":32,"alternative-id":["10.3389\/fpsyg.2022.722985"],"URL":"https:\/\/doi.org\/10.3389\/fpsyg.2022.722985","relation":{},"ISSN":["1664-1078"],"issn-type":[{"value":"1664-1078","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,10]]},"article-number":"722985"}}