Prescriptions of Psychopharmaceuticals in High-Security Hospitals

This study investigates prescriptions of psychopharmaceuticals in high-security forensic psychiatric centers in Flanders, Belgium, focusing on a population with diverse psychiatric comorbidities and high rates of substance use disorders. Using a cross-sectional design, data from July 1, 2023 ( N  = 439) were collected from pharmacy records and medical files. Analyses examined types of psychopharmaceuticals, dosing patterns, polypharmacy, off-label use, and alignment with clinical guidelines. Antipsychotics were the most prescribed class, often at high doses and in polypharmacy regimens, including for patients without psychotic disorders. Clozapine was used less frequently than expected, and a therapeutic drug monitoring was frequently incomplete. Antidepressant medications and mood stabilizers were widely prescribed, often off-label, especially among patients with personality disorders. Medications with dependence potential and libido-suppressing drugs were used minimally and typically according to recommendations. Overall, psychopharmaceutical prescribing in high-security hospitals in Flanders is characterized by frequent polypharmacy, high-dose treatment, and extensive off-label use. Ethical considerations remain central, particularly regarding coercive medication and monitoring practices. Further research is needed to evaluate clinical and forensic outcomes associated with these prescribing patterns.