Date of Award

1-1-2009

Document Type

Campus Access Dissertation

Department

College of Nursing

Sub-Department

Nursing Practice

First Advisor

Kathleen M. Scharer

Abstract

Forensic psychiatric patients with a diagnosis of schizophrenia are treated in designated state mental health hospitals. Treatment encompasses three goals: (a) reducing or eliminating symptoms, (b) maximizing quality of life, and (c) promoting and maintaining recovery from the debilitating effects of the disease. Schizophrenic patients who have been opined Not Guilty by Reason of Insanity (NGRI) tend to have frequent bounce back hospitalizations from violating some aspect of their General Sessions Court order or from decompensation of their conditions. Nonadherence, one of the major factors, is increasingly regarded as one of the foremost challenges facing professionals in modern healthcare, and it is a topic that has in general been under-addressed as a crucial issue for public health. Study findings have indicated that atypical antipsychotics were equal or superior to conventional antipsychotics in symptom remission and prevention of relapse, but literature regarding psychopharmacological treatment in the population of mentally ill offenders has remained limited. It has been suggested that conventional depot neuroleptics continue to be underused for this population and that both conventional and atypical depot agents may be the best first line medications. Researchers have pointed out that long-acting agents when dosed appropriately carry no more adverse emergent effects than their oral equivalents. Studies of the effect of medication adherence in NGRI schizophrenic patients on the number of hospitalizations could not be found. The purpose of this review was to determine if there is sufficient knowledge to determine how the use of three long-acting injectable antipsychotic medications with forensic patients may affect relapse and rehospitalization rates as compared to patients who are not on them.

There are risks and benefits for prescribing either one of the two available conventional depot antipsychotic preparations or the atypical agent. Guidelines are presented for using these agents with forensic schizophrenic patients in an effort to enhance outpatient treatment success, maximize recovery, and reduce relapse and rehospitalization rates. Suggestions are given for further investigation into answering the PICO question, "Do forensic patients with a diagnosis of schizophrenia who are on depot antipsychotic medications have fewer hospitalizations than those who are not on them?".

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