Background:
Mentally disordered offenders provided with forensic psychiatric care are often treated with second generation antipsychotic medication (AP) and experience metabolic and inflammatory side effects. Disturbances in liver and kidney function are referred in literature, with main focus on those provoked by the first generation.

Aim:
The aim of the current investigation was to study the three-year fluctuation of selected liver and kidney function markers in forensic psychiatric patients receiving antipsychotic (AP) medication for more than five years, according to the type of ΑP.

Methods:
Thirty-five patients with psychotic disorders were classified into two groups based on the type of AP. Specifically: AP1, related to a lower risk, namely aripiprazole, amisulpride quetiapine XR, paliperidone, and ziprasidone, and AP2, related to an increased risk of weight gain and metabolic complications, namely olanzapine, asenapine, clozapine and risperidone. Medication and biochemical data relevant to liver and kidney function were retrieved from the individual medical files, specifically: urea, uric acid, creatinine, SGOT, SGPT, γ- GT, alkaline phosphotase, and amylase.

Results:
AP1 group of patients did not differ significantly in any biochemical substance over time. Both overall between the three time periods and in each pair of periods the patients of the AP1 group present approximately the same pattern to each biochemical feature.On the other hand, patients in the AP2 group differ significantly in uric acid (p = .015), SGOT (p = .018) and SGPT (p = .051) levels in at least one measurement compared to the others. Specifically, patients show significantly higher uric acid in the third time period than in the second (p = 0.014). It is worth noting that despite the apparent equality of creatinine values between the three time periods. It is observed that patients in the AP2 group showed significantly higher creatinine in the third time period compared to the second (p = 0.029). Furthermore, SGOT levels for this group (AP2) of patients are significantly higher in the second time period compared to the first (p = 0.038). Finally, patients show significantly lower levels of SGPT in the third time period compared to the second period (p = 0.024). In each case the values of the biochemical characteristics in each of the 3 time periods are reflected by the mean or median value calculated in each case.

Conclusions:
AP2 antipsychotics are more relevant to liver and kidney dysfunction. Therefore, the strategy behind choosing an antipsychotic drug should consider its hepatotoxicity and kidney damage, in addition to other complications, such as cardiovascular disease, obesity and metabolic syndrome.