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PRIMARY RESEARCH

Open Access

The development and trial of a medication discontinuation program in the department of forensic psychiatry Kenji Murasugi1,2*, Teruomi Tsukahara3 and Shinsuke Washizuka2

Abstract Background: When treating mentally ill criminal offenders, improving medication adherence is essential to achieving goals, such as long-term stabilization of symptoms and the prevention of recidivism. Most subjects who are treated under the Medical Treatment and Supervision Act have schizophrenia, which is considered a particularly difficult disorder for which to improve medication adherence. For such patients, we developed a Medication Discontinuation Program (MDP) that aims to improve medication adherence by discontinuing antipsychotic drugs and monitoring changes in psychiatric symptoms. We examined whether there was any utility for the MDP on a trial basis as well as whether it would be worthwhile to introduce the MDP to psychiatric programs. Methods: We conducted the MDP with an intervention group (n = 7) and compared Drug Attitude Inventory-30 (DAI-30) scores before and after implementation of the MDP. We also categorized 30 questions of the DAI-30 into three subscales: “awareness of the need for medication”, “awareness of the effects of psychiatric drugs”, and “impression of medication”, and examined factors affecting improvement in medication adherence. Results: The total DAI-30 score significantly increased after completion of the MDP (P = 0.002). Significant elevations after completion of the MDP were also observed in the scores for three subscales of the DAI-30. Conclusions: Our study suggests that the MDP has a possibility of improving medication adherence, and this program might have multidirectional and stimulatory effects on each factor related to the improvement of medication adherence. Keywords: Medical Treatment and Supervision Act, Adherence, Medication Discontinuation Program, Schizophrenia, Drug Attitude Inventory-30

Background The preparation of special treatment systems and facilities is important so that mentally ill people who have committed crimes can be provided with appropriate treatment and avoid recidivism. However, no such system was in place in the late 19th century when scientific medicine was introduced to Japan. More surprisingly, no system was developed in Japan until the early 21st century. Forensic support services in Japan lag far behind those in European countries and the United States, and * Correspondence: [email protected] 1 Department of Psychiatry, National Hospital Organization, Komoro Kogen Hospital, 4598 Kou, Komoro, Nagano 384-8540, Japan 2 Department of Psychiatry, Shinshu University School of Medicine, Nagano, Japan Full list of author information is available at the end of the article

recently, this need was recognized. As a result, the Act on Medical Care and Treatment for Persons Who Have Caused Serious Cases Under the Condition of Insanity (hereafter, the Medical Treatment and Supervision Act (MTSA)) was signed into law on 15 July, 2005, as the first