The use of clozapine in the forensic population in Europe.

This article reviews the use of clozapine, an antipsychotic medication, within European forensic psychiatric populations, focusing on its clinical application, prescribing patterns, and effects on aggression and violence. Clozapine is recognized as the most effective treatment for treatment-resistant schizophrenia and has demonstrated benefits in reducing hostility and aggressive behaviors, including in patients with antisocial and borderline personality disorders, although evidence for off-label use remains limited. The review of nine European studies, primarily involving male patients diagnosed with schizophrenia and housed in high-security settings, indicates that clozapine is frequently prescribed—often alongside other psychotropics—and is associated with reductions in violent incidents and improved impulse control. Despite its clinical utility, clozapine’s use is constrained by side effects, monitoring requirements, and ethical concerns related to informed consent in coercive forensic contexts. The authors emphasize the need for further rigorous research to clarify clozapine’s mechanisms in aggression reduction and to optimize its risk-benefit profile in forensic psychiatry.