Assessing the appropriateness of the prescription of psychiatric medications in prison.

Although critics have argued that psychiatric medications in correctional settings are often prescribed in a clinically irrational manner, without adequate diagnostic criteria, and for the purposes of coercive control rather than treatment, there has been no systematic research in an attempt to validate these claims. The present study examines the influence of inmate clinical and social characteristics, as well as prison setting factors, on the prescription of psychiatric medication to New York State prison inmates. Study findings show that clinical characteristics predominate in the psychiatric medication prescription process. Specifically, psychiatric impairments, measured in terms of levels of depression, manifest symptomatology, agitation, and prior psychiatric hospitalization were found to be highly significant predictors of drug prescription. This finding suggests clinically appropriate use. Some researchers have suggested that the influence of patient social characteristics on psychiatric treatment is greatest when patient symptomatology is less severe. The conditional effect of inmate social characteristics on drug prescription was examined by levels of inmate impairment, and differences were found. The decision to prescribe medication for mildly impaired inmates appears to be influenced by social factors. However, when an inmate's behavior is unquestionably bizarre or disruptive, social status characteristics are less likely to influence physicians' clinical judgments.