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<p>The treatment of schizophrenic patients in forensic psychiatric facilities represents one of the central challenges at the interface between psychiatry, law and society. Evidence-based psychopharmacotherapy forms the core of the treatment of schizophrenic disorders but the transferability of international guidelines to the forensic psychiatric patient population is limited. Antipsychotic therapy not only serves to alleviate symptoms but also to reduce dangerousness. The aim of this article is to present the current data on psychopharmacological treatment strategies for schizophrenic patients in forensic psychiatric hospitals, to present empirical data from the Berlin Forensic Psychiatric Hospital and to discuss the results in the context of international research. The focus is on issues of evidence-based practice, adherence, polypharmacy, high-dose therapy, the role of clozapine and the relevance of depot antipsychotic drugs. In addition, the frequency and legal framework of compulsory drug treatment are examined. Data from the Berlin Forensic Psychiatric Hospital (Krankenhaus des Maßregelvollzugs Berlin, KMV) show that a&#xa0;significant proportion of patients do not receive high-dose therapies but receive clozapine and depot formulations instead. A&#xa0;key finding is the discrepancy between study populations and the highly complex forensic clientele, which is often characterized by treatment resistance, comorbidities and chronic disease progression. This discrepancy highlights the urgent need to involve forensic patients more closely in research and to align guideline development with real care populations. Finally, the extent to which forensic commitment is increasingly taking on the role of a&#xa0;substitute care system for the severely mentally ill is discussed, along with the ethical, political, care structural, and social implications of this development.</p>

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Psychopharmakotherapie bei schizophrenen Patient:innen im Maßregelvollzug – evidenzbasierte Psychopharmakotherapie zwischen Leitlinien, klinischer Realität und forensischen Spezifika

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  • 发表日期：

    2026年4月13日

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  • Julia Krebs

摘要

The treatment of schizophrenic patients in forensic psychiatric facilities represents one of the central challenges at the interface between psychiatry, law and society. Evidence-based psychopharmacotherapy forms the core of the treatment of schizophrenic disorders but the transferability of international guidelines to the forensic psychiatric patient population is limited. Antipsychotic therapy not only serves to alleviate symptoms but also to reduce dangerousness. The aim of this article is to present the current data on psychopharmacological treatment strategies for schizophrenic patients in forensic psychiatric hospitals, to present empirical data from the Berlin Forensic Psychiatric Hospital and to discuss the results in the context of international research. The focus is on issues of evidence-based practice, adherence, polypharmacy, high-dose therapy, the role of clozapine and the relevance of depot antipsychotic drugs. In addition, the frequency and legal framework of compulsory drug treatment are examined. Data from the Berlin Forensic Psychiatric Hospital (Krankenhaus des Maßregelvollzugs Berlin, KMV) show that a significant proportion of patients do not receive high-dose therapies but receive clozapine and depot formulations instead. A key finding is the discrepancy between study populations and the highly complex forensic clientele, which is often characterized by treatment resistance, comorbidities and chronic disease progression. This discrepancy highlights the urgent need to involve forensic patients more closely in research and to align guideline development with real care populations. Finally, the extent to which forensic commitment is increasingly taking on the role of a substitute care system for the severely mentally ill is discussed, along with the ethical, political, care structural, and social implications of this development.