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.
Dopamine Antagonist Antipsychotics in Diverted Forensic Populations
Michael A. Cummings, George J. Proctor, and Ai-Li W. Arias
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.
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