1. Mental Health Western Brabant,
Comorbidity and Use of Psychotropic Drugs in Male Domestic Violence Offenders
P. Michielsen
Psychiatrist
Mental Health Western Brabant,
The Netherlands

2. Conflict of Interest: None.

4. Background
Little is known about characteristics of male domestic violence perpetrators.
There are 3 subtypes in domestic violence perpetrators (Holtzworth-Munroe 1994)
In Intermittent explosive disorder there are a few epidemiological data on comorbidity (Kessler ea 2006, Shorey ea 2012) , but no studies exist on psychotropic drugs use.

5. Aims of the Study
What categories of psychotropic drugs are prescribed in an outpatient health Clinic treating male domestic violence offenders? What is the point prevalence and distribution of Comorbidity on axis I (CPDI)
Are Self Reported Aggression (SRI) and CPDI predictors of psychotropic drugs use?
Is SRI level a predictor of CPDI?

6. Method
2 outpatient Clinics in Western Brabant, the Netherlands (population 280,000 inhabitants)
Retrospective study on patients records in the period
N=303 patients referred to aggression program.
Referral by GP, or rarely probation (8%).
Patients seen on entry by psychiatrist for assessment.
Then entry in group CBT program targeting impulsive and aggressive behaviour.

7. Method(II)
Inclusion criteria: Treatment for male domestic violence perpetrators on a voluntary basis Age yrs.
Exclusion:
Involuntary/Juridicial refferal
Learning Disability (IQ<70)
Neurological cause/ Head Injury

8. Assessment Tools
Axis I comorbidity assessed by psychiatrist (total 8) based on DSM-IV-TR criteria
CPDI does include any Axis I diagnosis other than V-codes, adjustment disorders and any impulse control disorder.
Severity of aggression: BDHI-D
Use of psychotropic drugs: retrieved from records ( electronic prescriptions combined with information from GP’s)

9. Results: Age Distribution
Mean age = 40

10. Sample Characteristics
- Ethnicity: 92 % Domestic
2,4 % Western Allochtonous
5,6 % Non-Western Allochtonous
- Number of Axis I diagnoses :
0 : 40,9 %
1: 44,6 %
2 and over: 14,5 %
Number of psychotropic drugs (categories):
0: 42,5 % 1: 28,3 % 2 : 18,7 % 3<: 10,5 %

11. Axis I disorders

12. Categories of psychotropic drugs

13. Psychotropic Drugs(II)
GP’s prescribed mainly benzodiazepines for sleep difficulties, while psychiatrists preferred other categories.
The use of hypnotics is high indicating a lot of (unrecognised) sleep difficulties.
Mood stabilisers (lithium, valproate,…) are rarely prescribed in this sample.

14. Are Self Reported Aggression (SRI) and CPDI predictors of psychotropic drugs use?
Logistic regression used with psychotropic drugs use as dichotomous variable.
CPDI is strong predictor (OR=7,44; p<0,05)
Direct (OR=1,10,; p<0,05) and Indirect aggression (OR=1,06; p<0,05) are not.
This suggests medication was primarely prescribed for other axis I disorders, not for the aggression itself.

15. Is SRI level a predictor of CPDI?
We used CPDI as dichotomous entity and the number of diagnoses as outcome measures, using logistic regression techniques for binary and nominal variables.
There was no significant relationship between SRI and CPDI in total and not for separate axis I categories.
There was a significant effect for number of diagnoses: 1 diagnosis (OR=2,57; p<0,05) and 2 diagnoses (OR=5,73;p<0,05)

16. Conclusions
We found many actual axis I diagnoses in this sample, mainly mood disorders, substance use and ADHD. Anxiety disorders and PTSD were underrated. For PTSD this warrants further investigation.
Sleep difficulties are common in male domestic violence perpetrators
There was a clear relationship between CPDI and psychotropic drugs use, but not between SRI and psychotropic drugs use.
Different drug categories are used by GP’s and psychiatrists, mood stabilisers are underused in view of their efficacy in studies.
Guidelines are needed to assess who is elegible for psychotropic drugs use and who’s not.