Antipsychotics are a class of drugs used primarily in the management of psychosis (including delusions, hallucinations, paranoia or disordered thinking), mainly in schizophrenia and bipolar disorder. However, they are being used increasingly to treat non-psychotic disorders. Antipsychotics are typically classified as typical or atypical antipsychotics. Generally speaking, antipsychotic medications work by blocking a specific subtype of the dopamine receptor called the D2 receptor in the dopaminergic pathways, specifically the mesolimbic pathway. This means that dopamine released in these pathways has less of an effect.
Typical antipsychotics such as haloperidol and chlopromazine are not as selective and block D2 receptors in other pathways outside of the mesolimbic pathway. This can result in unwanted side effects and an increase in the negative symptoms associated with the illness.
Atypical antipsychotics such as clozapine and quetiapine block D2 receptors as well as a specific type of serotonin receptor, the 5HT2A receptor. It is believed that 5-HT2A antagonism increases dopamine’s effect in some of the dopaminergic pathways leading to fewer side effects in atypical antipsychotics.
Several studies have suggested that criminal offenders are more likely to have psychosis than non-criminals. In fact, there has been evidence that gang members are seven times more likely to have psychosis (Coid et al., 2013). Chang, Lichtenstein, Långström, Larsson & Fazel (2016) studied the effects of antipsychotic medications on criminal offenders who were released from prisons in Sweden between 2005 and 2010. There was a 42 per cent reduction in the rate of violent reoffending in released offenders who were prescribed antipsychotic medications.
However, the study did not specify what mental illnesses the prisoners had which makes it difficult to know which illnesses may be best treated with the antipsychotics. Future research studies like this should specify the mental illnesses of offenders which would allow us to make more accurate predictions about the mental illnesses that are best treated with antipsychotics Furthermore, as mentioned above, one of the drawbacks in using antipsychotics to treat people is that these medications have numerous side effects including cardiovascular problems, sedation, and weight gain (Soller, Karnik, & Steiner, 2006). In order for benefits to outweigh the costs, physicians must carefully monitor the dosage of antipsychotics and their effects on offenders’ health. Therefore, these offenders must have regular access to healthcare so that their progress can be routinely checked. Antidepressants.
Antidepressants are drugs that are used in treating major depressive disorder in addition to other conditions such as some anxiety disorders, some chronic pain conditions, and to help manage some addictions. They work by altering chemical imbalances of neurotransmitters in the brain. Specifically, they inhibit the reuptake of neurotransmitters through selective receptors. This means that instead of neurotransmitters being reabsorbed back into nerve cells, they neurotransmitter can stay longer in the synapses between nerves. This causes an increase in the concentration of specific neurotransmitters in the brain which can improve communication in the nerve cells and strengthen n circuits in the brain which regulate mood. Chang et al. (2016) found that antidepressants were not associated with significant differences in violent reoffending rates. However, they suggested that this was because individuals with depression are less violent than individuals with other mental illnesses which could mean that antidepressants may be less effective than other medication to reduce violent offending. However, antidepressants may be effective in reducing non-violent reoffending. Spiller & Sawyer (2007) suggests that continuous use of antidepressants reduce the chances of being arrested for driving under the influence. This provides evidence for the idea that antidepressants may reduce the rate of non-violent reoffending. To further strengthen this notion, further studies should be done on the rates of non-violent crime when offenders with mental illness are treated with antidepressants.
Mood stabilizers are used treat mood disorders with intense and sustained mood shifts, typically bipolar disorders, borderline personality disorder (BPD) and schizoaffective disorder. Though, the molecular mechanisms underlying the actions of these drugs are unknown, some have proven quite effective in their treatment of these disorders (Smith, Cornelius, Warnock, Bell & Young, 2007). Mood stabilizers have been associated with violent crime reduction in bipolar disorder (Fazel, Zetterqvist, Larsson, Långström & Lichtenstein, 2014). Further studies can be done to find associations between mood stabilizers and violent crime reduction in other mood disorders such as BPD. Pychostimulants. Psychostimulants, or simply stimulants, are a class of drugs that increase brain activity. These drugs can temporarily increase awareness, mood and alertness. They are often used in the treatment of attention deficit hyperactivity disorder(ADHD). Many stimulants work through monoamine transmission manipulations.
Monoamines are a class of neurotransmitter that include, dopamine, norepinephrine, and serotonin which are relevant in reward, motivation, temperature regulation and pain sensation. Stimulants usually block the reuptake or stimulate the efflux of dopamine and norepinephrine resulting in increased amount of these neurotransmitters in the brain. The use of stimulants in treating ADHD has been associated with crime rates in many studies. Lichtenstein et al. (2013) found that in patients with ADHD, crimes occurred less often during periods with ADHD medication. The estimated probability of being convicted for a crime during 4 years for those on medication was significantly lower than the probability for those not on medication. Furthermore, Chang et al. (2016) found that the use of psychostimulants in prisoners previously diagnosed with ADHD was significantly associated with reductions in violent reoffending rates. However, as noted by Appelbaum (2011) there is a potential risk of abuse by inmates. Twelve percent of state prisoners report having used stimulants during the month prior to their offense, which provides some indication of the market potential for these drugs (Mumola & Karberg, 2004). There may be attempts at malingering in order to obtain prescriptions for these stimulants due to easy access to the diagnostic criteria used by prescribers.
Therefore, careful screenings to differentiate truly impaired patients from those seeking medications for recreational use or profit is necessary. This is in addition to a close monitoring of medication administration by nursing and correctional staff. In this way patients and staff benefit. Drugs for substance use disorders. Chang et al. (2016) found that medications for substance use disorders were also found to have significant associations with reduced violent offending in prisoners that were previously diagnosed as having a substance use disorder. However, specific substance use disorders were not highlighted which would lead to generalizations about different substance use disorders and the effectiveness of medications on them (i.e. medications are successful in reducing violent offending in all substance use disorders). More research should be done to find out which medications are most effective for certain types of substance use disorders such as alcohol use disorder, opioid use disorder etc.