Decriminalizing Mental Illness

9781108826952

Reports reveal an increase in the number of individuals with serious mental illness in jails, prisons and forensic hospitals. Despite the wide-ranging and devastating consequences of this 'criminalization' of mental illness, there remains a lack of information on the subject as well as on the provision of care for these patients. This important new book fills a gap in the literature by examining topics such as: the history and policy factors related to criminalization; original research on forensic populations; pharmacological and psychological treatment strategies; and principles and guidelines for diversion out of the criminal justice system. Contributions from leading experts in the field further our understanding of this important subject, offering advice on how to provide humane care for patients. A must have for all mental health clinicians including psychiatrists, psychologists, social workers, rehabilitation therapists, and mental health nurses. A useful tool for mental health administrators and policy makers.

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Chapter 18 Dopamine Antagonist Antipsychotics in Diverted Forensic Populations

Introduction
Principle Text
Mechanisms
Antipsychotic Trials
Conclusions
Disclosure
References

Michael A. Cummings , George J. Proctor , and Ai-Li W. Arias

Introduction

In community settings, the principle barriers to independent living, stable relationships, and gainful employment arise from the negative and cognitive symptom domains of schizophrenia spectrum disorders.¹^,² In contrast, the positive symptoms of psychosis often are the gateway (e.g. via persecutory delusion associated with anger) to arrest and criminalization for the mentally ill.³^,⁴ Since the clinical discovery of chlorpromazine in 1952, dopamine antagonism in the mesolimbic dopamine circuit has been central to treating the positive symptoms of psychosis.⁵^,⁶ The hyperactivity of the mesolimbic circuit and the normalizing effects of the dopamine antagonist antipsychotics are illustrated in Figure 18.1.

Figure 18.1

Mesolimbic pathway and D₂ antagonists.

In this review, we seek to understand the roles of dopamine antagonist antipsychotics, including the use of long-acting or depot formulations and plasma concentrations, in controlling the positive symptoms of psychosis, thereby supporting decriminalization of those suffering from psychotic disorders.⁷