JAMA
November 1, 2016, Vol 316, No. 17, Pages 1731-1838
http://jama.jamanetwork.com/issue.aspx

.
Research Letter
Tdap Vaccination During Pregnancy and Microcephaly and Other Structural Birth Defects in Offspring
Malini DeSilva, MD, MPH; Gabriela Vazquez-Benitez, PhD; James D. Nordin, MD, MPH; et al.
JAMA. 2016;316(17):1823-1825. doi:10.1001/jama.2016.14432
This cohort study uses Vaccine Safety Datalink data to examine associations between maternal Tdap vaccination and structural birth defects in offspring.
.
Editorial
November 1, 2016
Mental Illness, Release From Prison, and Social Context
Jeffrey Swanson, PhD1
JAMA. 2016;316(17):1771-1772. doi:10.1001/jama.2016.12434
Zheng Chang, PhD; Paul Lichtenstein, PhD; Niklas Långström, MD; Henrik Larsson, PhD; Seena Fazel, MD
[Initial text]
Revolving in and out of prisons and jails is no way to recover from a devastating disease like schizophrenia—but that is the challenge facing too many people with serious mental illnesses. In addition to complex health needs that often include substance misuse and medical comorbidities, mentally ill individuals who reenter the community from prison are at risk for unemployment, homelessness, and criminal recidivism.1 What role does treatment with psychotropic medications have in improving outcomes for this population?…

.

Original Investigation
November 1, 2016
Association Between Prescription of Major Psychotropic Medications and Violent Reoffending After Prison Release
JAMA. 2016;316(17):1798-1807. doi:10.1001/jama.2016.15380
Zheng Chang, PhD1,2; Paul Lichtenstein, PhD1; Niklas Långström, MD1,3; et al Henrik Larsson, PhD1,4; Seena Fazel, MD2
Author Affiliations
Key Points
Question
Is the use of psychotropic medications associated with a lower risk of reoffending for violent crime among released prisoners?
Findings
In this cohort study of 22 275 released prisoners, 3 classes of psychotropic medications (antipsychotics, psychostimulants, and medications used for addictive disorders) were associated with statistically significant hazard ratios (0.58, 0.62, and 0.48, respectively) of violent reoffending.
Meaning
Evidence-based provision of psychotropic medications to released prisoners was associated with lower risk of reoffending.

Abstract
Importance
Individuals released from prison have high rates of violent reoffending, and there is uncertainty about whether pharmacological treatments reduce reoffending risk.
Objective
To investigate the associations between major classes of psychotropic medications and violent reoffending.
Design, Setting, and Participants
This cohort study included all released prisoners in Sweden from July 1, 2005, to December 31, 2010, through linkage of population-based registers. Rates of violent reoffending during medicated periods were compared with rates during nonmedicated periods using within-individual analyses. Follow-up ended December 31, 2013.
Exposures Periods with or without dispensed prescription of psychotropic medications (antipsychotics, antidepressants, psychostimulants, drugs used in addictive disorders, and antiepileptic drugs) after prison release. Prison-based psychological treatments were investigated as a secondary exposure.
Main Outcomes and Measures
Violent crime after release from prison.
Results
The cohort included 22,275 released prisoners (mean [SD] age, 38 [13] years; 91.9% male). During follow-up (median, 4.6 years; interquartile range, 3.0-6.4 years), 4031 individuals (18.1%) had 5653 violent reoffenses. The within-individual hazard ratio (HR) associated with dispensed antipsychotics was 0.58 (95% CI, 0.39-0.88), based on 100 events in 1596 person-years during medicated periods and 1044 events in 11 026 person-years during nonmedicated periods, equating to a risk difference of 39.7 (95% CI, 11.3-57.7) fewer violent reoffenses per 1000 person-years. The within-individual HR associated with dispensed psychostimulants was 0.62 (95% CI, 0.40-0.98), based on 94 events in 1648 person-years during medicated periods and 513 events in 4553 person-years during nonmedicated periods, equating to a risk difference of 42.8 (95% CI, 2.2-67.6) fewer violent reoffenses per 1000 person-years. The within-individual HR associated with dispensed drugs for addictive disorders was 0.48 (95% CI, 0.23-0.97), based on 46 events in 1168 person-years during medicated periods and 1103 events in 15,725 person-years during nonmedicated periods, equating to a risk difference of 36.4 (95% CI, 2.1-54.0) fewer violent reoffenses per 1000 person-years. In contrast, antidepressants and antiepileptics were not significantly associated with violent reoffending rates (HR = 1.09 [95% CI, 0.83-1.43] and 1.14 [95% CI, 0.79-1.65], respectively). The most common prison-based program was psychological treatments for substance abuse, associated with an HR of 0.75 (95% CI, 0.63-0.89), which equated to a risk difference of 23.2 (95% CI, 10.3-34.1) fewer violent reoffenses per 1000 person-years.
Conclusions and Relevance
Among released prisoners in Sweden, rates of violent reoffending were lower during periods when individiduals were dispensed antipsychotics, psychostimulants, and drugs for addictive disorders, compared with periods in which they were not dispensed these medications. Further research is needed to understand the causal nature of this association.