Commentary: Antipsychotic Prescribing Practices in the Texas Prison System

• NCJ Number: 188600
• Journal: Journal of the American Academy of Psychiatry and the Law Volume: 29 Issue: 1 Dated: 2001 Pages: 54-57
• Author(s): Robert L. Trestman Ph.D.
• Date Published: 2001
• Length: 4 pages
• Publication Format: Article
• Publication Type: Legislation/Policy Analysis
• Language: English
• Country: United States of America
• Note: For the study report, see NCJ-188599.

Annotation

This commentary on antipsychotic prescribing practices in the Texas prison system focused on the diagnoses and target symptomatology for antipsychotic medication, medication selection and management, and potential racial and gender bias in the treatment of incarcerated patients.

Abstract

Clearly, antipsychotic medication is indicated in the treatment of the schizophrenias and schizophrenia-like disorders, as well as the psychoses associated with bipolar disorder, psychotic depression, and many drug intoxication states. In the study of antipsychotic prescribing practices in the Texas prison system, no particular selection bias was found in the use of atypical versus typical antipsychotic medications where there was a history of violent behavior in someone with a psychotic disorder; however, there were preliminary data to support the preferential use of atypical antipsychotics in the treatment of violence in the context of chronic psychosis, with many methodological caveats noted. The lack of data on this issue argued for the need to address explicitly the question of the relative benefit of the atypical antipsychotics in the treatment of aggression, violence, and impulsive violence, with or without associated psychosis in the correctional setting. One of the concerns identified in the study of antipsychotic prescribing practices in the Texas prison system was the small number of African-American inmates treated with atypical antipsychotic medication compared with the more traditional antipsychotic medications. These data raised concerns about the potential for racial bias in the selection of antipsychotic medication for various inmates. A similar finding was noted regarding the use of the more expensive atypical antipsychotics with women inmates. The use of prescribing guidelines based only on disease-related factors could help counter the potential for bias in prescribing antipsychotic medicines for inmates. 35 references