Individuals with threatening or violent criminal behavior: civil commitment or release after incarceration?

Patients who have diagnoses of a major mental illness and an antisocial personality disorder present administrative, clinical, legal, and ethical challenges. Based on an actual case, the authors discuss how clinicians could fulfill the obligation to the patient, mental health system, judicial system, and the community under these circumstances. We explore how clinical presentation of symptomatology and criminal behavior contribute to challenges in determining psychiatric care.

Continuing day treatment programs promote recovery in schizophrenia: a case-based study.

Continuing day treatment programs focus on community stabilization through comprehensive individualized rehabilitation. They promote recovery through a variety of practical clinical therapeutic interventions. This empirically based report describes a continuing day treatment program's rehabilitation of four clients with schizophrenia, chronic type in a western New York mental health clinic who were in each of the specialty services: a two-phase program, a program for seniors, and a program for co-occurring substance dependence. Some particularly difficult psychiatric symptoms of schizophrenia were successfully treated in this continuing day treatment program. Each of these clients showed improvements in their symptoms and overall community adjustment that may well have been unobtainable with less intensive outpatient treatment.

Risperidone long-acting injections: successful alternative deltoid muscle injections for refractory schizophrenia.

Treatment-resistant paranoid schizophrenia is often addressed with long-term intramuscular preparations of conventional antipsychotics (haloperidol and fluphenazine), which can be associated with the development of painful, lumpy nodules at the injection site. In this article, we present a case example of a 58-year-old male patient with paranoid schizophrenia who was treated with risperidone long-acting injection given into the deltoid muscle instead of the US Food and Drug Administration (FDA)-approved gluteal muscle injection site. Use of this agent in the deltoid muscle facilitated healing of the numerous painful lumpy nodules associated with prior trials of conventional long-acting injections. In addition, the patient's psychiatric outcome was improved relative to what had been observed with the previous agents.