Thread by @seenafazel

Our new paper examines associations between specific antipsychotics and a wide range of crime outcomes, incl. arrests and convictions for violent and drug-related offences. Analyses data on all prescriptions 2006-13 in Sweden. Some novel findings. #OA: cambridge.org/core/journals/… 1/

First, the overall pattern emerges that antipsychotics are associated with clear reductions in all crime outcomes. Shown in between-individual models (crime rates in people dispensed meds vs those not dispensed meds) - among the persons who were prescribed antipsychotics 2/

Also found in within-individual models - where crime rates are compared within each individual (during periods on and off medication in the same person). Figure shows rate ratios adjusted for age and other meds (where less than 1 equates to risk reduction on antipsychotics) 3/

Also investigated individual antipsychotics, and reported an overall rank across all 6 crime outcomes. Suggests heterogeneity in their effects on crime outcomes. Consistent with recent network meta-analysis on side effects and other outcomes: thelancet.com/article/S0140-… 4/

In other words, when considering which antipsychotic to use, these data can help inform that decision if someone has criminal/violent history or considered at elevated risk. Risperidone/olanzapine associated with greater risk reduction than haloperidol/quetiapine. 5/

The clozapine association replicates findings from trials and other observational studies on violence, e.g. see study @DrVishalBhavsar: academic.oup.com/schizophreniab…. However we also found associations c/ reduced any offending with clozapine, probably reflecting larger sample size. 6/

By linking evidence-based interventions (and not only medication) with better risk assessment (e.g. with OxMIV), new trials can test how to prevent crime and violence in people with mental illness 7/

Thanks to super collaborators @AmirSariaslan, Johan Zetterqvist, Stefan Leucht, and Paul Lichtenstein. And @wellcometrust for funding this work.