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Monitoring and improving antipsychotic adherence in outpatient forensic diversion programs

Published online by Cambridge University Press:  23 May 2019

Jonathan M. Meyer Open the ORCID record for Jonathan M. Meyer [Opens in a new window]
Jonathan M. Meyer*
Affiliation:
California Department of State Hospitals, Patton, CA, USA; Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
*
* Address correspondence to: Jonathan M. Meyer, California Department of State Hospitals; Department of Psychiatry, University of California, San Diego, 4225 Executive Square #600, La Jolla, CA 92037, USA. (Email: jmmeyer@ucsd.edu)
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Abstract

Outpatient diversion programs present an opportunity for severely mentally ill defendants to receive psychiatric treatment and have alleged offenses dismissed by the court. Moreover, the successful completion of pretrial diversion is associated with fewer post-program arrest and jail days. The target patient population for such programs is typically people with schizophrenia spectrum disorders, but the care of such patients in outpatient settings presents challenges for monitoring treatment fidelity, specifically antipsychotic adherence, as low adherence rates are associated with increased rates of recidivism. Presented here is a review of evidence-based strategies that must be employed to track antipsychotic adherence in outpatient diversion programs, including pill counts, use of long-acting injectable antipsychotics, and determination of plasma antipsychotic levels to assess adherence and the adequacy of antipsychotic treatment. Antipsychotic therapy remains the foundation of schizophrenia treatment, but only through the use of all available modalities can clinicians maximize the odds that schizophrenia patients in pretrial diversion maintain psychiatric stability and successfully complete mental health court mandates.

Keywords

Pretrial diversionrecidivismschizophreniaplasma levelmonitoringlong-acting injectable antipsychoticadherence
Type
Review
Information
CNS Spectrums , Volume 25 , Issue 2 , April 2020 , pp. 136 - 144
Copyright
© Cambridge University Press 2019

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