Treatment considerations in the forensic patient with schizophrenia

Research in new treatments for schizophrenia continues. At the same time, increasing numbers of persons with schizophrenia receive their treatment almost exclusively in correctional settings. Though the literature continues to describe this phenomenon in clearer detail, many questions regarding the characteristics of these mentally disordered offenders and their unique treatment needs remain. Research targeting this growing subset of persons with schizophrenia is limited. Risk factors that lead the person with schizophrenia into the correctional system, and whether the offenders with schizophrenia actually differ from non-offenders in terms of their psychopharmacological needs are significant questions that remain unaddressed. Countertransference towards the offender remains a significant issue as well. Given the many limitations on research in this population, pharmacologic strategies for the offender population must be extrapolated from the non-offender population. Traditional depot neuroleptics continue to be underutilized in the treatment of this population. It is argued that both traditional and forthcoming atypical depot neuroleptics may be the best first line agents in this population.