Patients in forensic psychiatric care (FPC) are commonly treated with a wide range of psychotropic medications. There is, however, a lack of understanding regarding how pharmacological treatment and psychotropic polypharmacy are used throughout care.

This register-based cohort study included patients admitted to FPC in Sweden between 2009 and 2020. We estimated the prevalence of the use of major psychotropic medication, as well as psychotropic polypharmacy, at admission and discharge. We also examined the change in antipsychotic use after admission.

In total, 1962 patients were included. Antipsychotics were the most used psychotropic medication class, with 86.2% (95%CI: 84.5–87.8) of patients receiving at least one typical or atypical antipsychotic at admission. Changes in the antipsychotic regime were more common at the beginning of FPC, compared to later time points. Within the subgroup of patients discharged during the study period (n = 561), there was a reduction in the use of typical antipsychotics (admission: 34.9%; discharge: 26.6%) and hypnotics and sedatives (admission: 37.4%; discharge: 28.1%). Other major medication classes remained relatively stable. The prevalence of psychiatric polypharmacy at admission was 70.6% (95%CI: 68.5–72.7) and remained similar during care.

Our study documented a high prevalence of antipsychotic use and psychotropic polypharmacy through FPC. Further, a high level of off-label antipsychotic use and antipsychotic polypharmacy was observed. Stronger evidence regarding the effectiveness and safety of these treatment strategies is needed.

Suicide screening is routine practice in psychiatric emergency (PE) departments, but evidence for screening instruments is sparse. Improved identification of nascent suicide risk is important for suicide prevention. The aim of the current study was to evaluate the association between the novel Colombia Suicide Severity Rating Scale Screen Version (C-SSRS Screen) and subsequent clinical management and suicide within 1 week, 1 month and 1 year from screening.

Consecutive patients (N = 18 684) attending a PE department in Stockholm, Sweden between 1 May 2016 and 31 December 2017 were assessed with the C-SSRS Screen. All patients (52.1% women; mean age = 39.7, s.d. = 16.9) were followed-up in the National Cause of Death Register. Logistic regression and receiver operating characteristic curves analyses were conducted. Optimal cut-offs and accuracy statistics were calculated.

Both suicidal ideation and behaviour were prevalent at screening. In total, 107 patients died by suicide during follow-up. Both C-SSRS Screen Ideation Severity and Behaviour Scales were associated with death by suicide within 1-week, 1-month and 1-year follow-up. The optimal cut-off for the ideation severity scale was associated with at least four times the odds of dying by suicide within 1 week (adjusted OR 4.7, 95% confidence interval 1.5–14.8). Both scales were also associated with short-term clinical management.

The C-SSRS Screen may be feasible to use in the actual management setting as an initial step before the clinical assessment of suicide risk. Future research may investigate the utility of combining the C-SSRS Screen with a more thorough assessment.