Dopamine antagonist antipsychotics in diverted forensic populations

Abstract

In community settings, negative symptoms and cognitive deficits are the primary barriers to independent living, stable relationships, and employment for individuals suffering from schizophrenia-spectrum disorders. In contrast, however, positive psychotic symptoms (e.g., command hallucinations and persecutory delusions) often drive behavior which serves as the gateway to arrest and criminalization. Historically, the keystone of treatment for positive psychotic symptoms has been antagonism of dopamine D2 receptors in the mesolimbic tract. In this article, we review and explore the principles underlying dopamine antagonism for the treatment of psychosis; optimization of dopamine antagonists in treating positive psychotic symptoms; the advantages of depot dopamine antagonist antipsychotics in forensic settings; the concepts of pharmacokinetic and pharmacodynamic treatment failures; and the role of medication plasma concentrations in optimizing and managing treatment.

Human iN neuronal model of schizophrenia displays dysregulation of chromogranin B and related neuropeptide transmitter signatures

“…Investigations in the field have determined that SZ is associated with elevated levels of the catecholamines dopamine, norepinephrine, and epinephrine [ 5 – 7 ]. This finding is further supported by the action of typical antipsychotics, which exert their therapeutic effects via dopamine receptor antagonism [ 8 – 10 ]. However, antipsychotics are unable to improve the cognitive dysfunction of SZ patients, which may be hypothesized to result from abnormalities in other neurotransmitter systems.…”

The Cal-DSH diversion guidelines

“…33 Thus, antipsychotic medications form the core of pharmacological treatment in diverted forensic populations. 34 Unfortunately, adherence to oral antipsychotics in outpatient settings, even when defined as taking only 80% of prescribed doses, is consistently less than 50%. 35,36 Due to enhanced adherence, LAI antipsychotics have proven superior to their oral counterparts in reducing crime and violence.…”