For individuals suffering from schizophrenia-spectrum disorders, the journey to reintegrating into society is fraught with various obstacles. In community settings, the primary barriers to independent living, stable relationships, and employment often encompass negative symptoms and cognitive deficits. However, in forensic settings – where individuals come into contact with the criminal justice system – it’s the positive psychotic symptoms, such as command hallucinations and persecutory delusions, that frequently trigger behaviors leading to arrest and criminalization.
A recent review article, published in the journal CNS Spectrums, delves into the critical role of dopamine antagonist antipsychotics in treating positive psychotic symptoms within diverted forensic populations. This elaborate report by Cummings Michael A., Proctor George J., and Arias Ai-Li W., from various prestigious institutions in California, highlights the advancement and strategic management of antipsychotic treatment to curb the symptoms that often result in judicial entanglements for affected individuals.
The DOI of this insightful review is 10.1017/S1092852919000841, indicating its presence in a credible academic database for reference and further study.
The foundation of treating positive psychotic symptoms has historically revolved around the antagonism of dopamine D2 receptors located in the mesolimbic tract, the pathway in the brain associated with the reward system, and a mediator of certain psychotic expressions. This article reviews the principles underlying this strategy, emphasizing the importance of optimizing dopamine antagonists for mitigating positive psychotic symptoms effectively.
Depot dopamine antagonist antipsychotics, owing to their long-acting nature, are particularly advantageous in forensic settings. These depot injections offer a consistent and sustained release of medication, improving adherence and, consequently, clinical outcomes. The review stresses the significance of overcoming both pharmacokinetic and pharmacodynamic treatment failures, where the former refers to the body’s impact on the drug and the latter to the drug’s impact on the body.
Furthermore, the authors of the report explore the role of monitoring medication plasma concentrations. By doing so, clinicians can fine-tune dosages to achieve optimal therapeutic levels, adjust for metabolic discrepancies among individuals, and manage potential side effects more efficiently.
References
1. Cummings, M. A., Proctor, G. J., & Arias, A. (2020). Dopamine antagonist antipsychotics in diverted forensic populations. CNS Spectrums, 25(2), 128–135. https://doi.org/10.1017/S1092852919000841
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Keywords
1. Antipsychotic Optimization
2. Dopamine Antagonists
3. Forensic Psychiatry
4. Schizophrenia Management
5. Long-Acting Antipsychotics
With schizophrenia affecting numerous lives globally, and capturing the intersection between mental health and law enforcement, this scholarly article broaches a salient topic. Medication adherence in psychiatric conditions such as schizophrenia is imperative for both the welfare of the patients and the safety of the community. By examining the efficacy and strategic employment of long-acting dopamine antagonist antipsychotics in forensic populations, Cummings and colleagues have underscored a nuanced approach to criminality prevention and psychiatric care coordination that is integral to both public health and the criminal justice system.
