Book contents
- Ethical and Clinical Complexities in the Treatment of Schizophrenia
- Ethical and Clinical Complexities in the Treatment of Schizophrenia
- Copyright page
- Contents
- Contributors
- Preface
- Part I Neuroscience
- Chapter 1 The Story of Schizophrenia
- Chapter 2 What Is the Neurobiology of Schizophrenia?
- Chapter 3 What Is Schizophrenia?
- Chapter 4 Assessment and Treatment of Anosognosia in Schizophrenia
- Chapter 5 Anosognosia in Schizophrenia
- Chapter 6 How Antipsychotics Work in Schizophrenia
- Chapter 7 Do Antipsychotics Work in People with Schizophrenia?
- Chapter 8 Do Antipsychotic Medications Work?
- Chapter 9 When Do Psychiatric Interventions Work?
- Chapter 10 Medications for Psychosis in People with Schizophrenia
- Chapter 11 Assisted Outpatient Treatment
- Chapter 12 Forensic Assertive Community Treatment
- Chapter 13 Does Compulsory Community Treatment for Discharged Forensic Hospital Patients Work?
- Chapter 14 Early Intervention for Schizophrenia
- Chapter 15 Cardiometabolic Disorders in Persons Living with Schizophrenia
- Part II International Policy Perspectives
- Part III Neuroethics
- Index
- References
Chapter 8 - Do Antipsychotic Medications Work?
An Exploration Using Competency to Stand Trial as the Functional Outcome
from Part I - Neuroscience
Published online by Cambridge University Press: 29 April 2026
Book contents
- Ethical and Clinical Complexities in the Treatment of Schizophrenia
- Ethical and Clinical Complexities in the Treatment of Schizophrenia
- Copyright page
- Contents
- Contributors
- Preface
- Part I Neuroscience
- Chapter 1 The Story of Schizophrenia
- Chapter 2 What Is the Neurobiology of Schizophrenia?
- Chapter 3 What Is Schizophrenia?
- Chapter 4 Assessment and Treatment of Anosognosia in Schizophrenia
- Chapter 5 Anosognosia in Schizophrenia
- Chapter 6 How Antipsychotics Work in Schizophrenia
- Chapter 7 Do Antipsychotics Work in People with Schizophrenia?
- Chapter 8 Do Antipsychotic Medications Work?
- Chapter 9 When Do Psychiatric Interventions Work?
- Chapter 10 Medications for Psychosis in People with Schizophrenia
- Chapter 11 Assisted Outpatient Treatment
- Chapter 12 Forensic Assertive Community Treatment
- Chapter 13 Does Compulsory Community Treatment for Discharged Forensic Hospital Patients Work?
- Chapter 14 Early Intervention for Schizophrenia
- Chapter 15 Cardiometabolic Disorders in Persons Living with Schizophrenia
- Part II International Policy Perspectives
- Part III Neuroethics
- Index
- References
Summary
This study explores the effectiveness of antipsychotic medications in restoring competency to stand trial in individuals with severe mental illness, particularly psychotic disorders. While antipsychotic medications are known for reducing symptoms of psychosis, this research focuses on their ability to improve functional outcomes necessary for competency to stand trial (CST). Among over 3,000 patients in California’s forensic state hospital system, 86.5% were successfully restored to competency, with 98.8% discharged on antipsychotic medications. Patients on antipsychotic monotherapy demonstrated higher restoration rates compared to those requiring additional mood stabilizers, suggesting that more complex cases demand more intensive treatment. Delusional disorder, traditionally seen as more resistant to treatment, showed a high restoration rate of 93.8% with antipsychotic use.Our findings emphasize the pivotal role of antipsychotics in not only reducing symptoms but also in restoring critical functional abilities for participation in legal proceedings. The functional improvements they enable extend beyond the courtroom. Incorporation of antipsychotic medication as an integral evidence-based mechanism in facilitating community reintegration for individuals with severe mental illness supports the broader goal of transitioning individuals from the legal system back into society, consistent with the ultimate promise of deinstitutionalization.
Keywords
Information
- Type
- Chapter
- Information
- Ethical and Clinical Complexities in the Treatment of SchizophreniaLiberty or Life, pp. 68 - 78Publisher: Cambridge University PressPrint publication year: 2026
References
Delay, J, Deniker, P, Harl, JM. Therapeutic use in psychiatry of phenothiazine of central elective action. Ann Med Psychol (Paris). 1952 Jun;110(21):112–117. PMID: 12986408.Google ScholarPubMed
Leucht, S, Tardy, M, Komossa, K, et al. Antipsychotic drugs versus placebo for relapse prevention in schizophrenia: a systematic review and meta-analysis. Lancet. 2012 Jun 2;379(9831):2063–2071. doi: 10.1016/S0140-6736(12)60239-6.CrossRefGoogle ScholarPubMed
Howner, K, Andiné, P, Engberg, G, Ekström, EH, et al. Pharmacological treatment in forensic psychiatry-a systematic review. Front Psychiatry. 2020 Jan 16;10:963. doi: 10.3389/ fpsyt.2019.00963.CrossRefGoogle ScholarPubMed
Singh, A, Delgado, D, Ventura, MI, et al. Clozapine use and forensic outcomes in psychiatric inpatients deemed incompetent to stand trial. J Am Acad Psychiatry Law. 2022 Sep;50(3):427–433. doi: 10.29158/JAAPL.210123-21.Google ScholarPubMed
Geddes, J, Freemantle, N, Harrison, P, Bebbington, P. Atypical antipsychotics in the treatment of schizophrenia: systematic overview and meta-regression analysis. BMJ. 2000 Dec 2;321(7273):1371–1376. doi: 10.1136/bmj.321. 7273.1371.CrossRefGoogle ScholarPubMed
Lieberman, JA, Stroup, TS, McEvoy, JP, et al. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med. 2005 Sep 22; 353(12):1209–1223. doi: 10.1056/NEJMoa051688.CrossRefGoogle ScholarPubMed
Jones, PB, Barnes, TR, Davies, L, et al. Randomized controlled trial of the effect on Quality of Life of second- vs first-generation antipsychotic drugs in schizophrenia: Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study (CUtLASS 1). Arch Gen Psychiatry. 2006 Oct;63(10):1079–1087. doi: 10.1001/archpsyc.63.10.1079.CrossRefGoogle ScholarPubMed
Haro, JM, Edgell, ET, Novick, D, et al. Effectiveness of antipsychotic treatment for schizophrenia: 6-month results of the Pan-European Schizophrenia Outpatient Health Outcomes (SOHO) study. Acta Psychiatr Scand. 2005 Mar;111(3):220–231. doi: 10.1111/j.1600-0447.2004.00450.x.CrossRefGoogle Scholar
Leucht, C, Heres, S, Kane, JM, et al. Oral versus depot antipsychotic drugs for schizophrenia – A critical systematic review and meta-analysis of randomized long-term trials. Schizophr Res. 2011 Apr; 127(1–3):83–92. doi: 10.1016/j.schres.2010.11.020.CrossRefGoogle ScholarPubMed
Tiihonen, J, Wahlbeck, K, Lönnqvist, J, et al. Effectiveness of antipsychotic treatments in a nationwide cohort of patients in community care after first hospitalisation due to schizophrenia and schizoaffective disorder: observational follow-up study. BMJ. 2006 Jul 29;333(7561):224. doi: 10.1136/bmj.38881.382755.2F.CrossRefGoogle Scholar
Tiihonen, J, Haukka, J, Taylor, M, et al. A nationwide cohort study of oral and depot antipsychotics after first hospitalization for schizophrenia. Am J Psychiatry. 2011 Jun;168(6):603–609. doi: 10.1176/appi.ajp.2011.10081224.CrossRefGoogle ScholarPubMed
Lambert, T, Olivares, JM, Peuskens, J, et al. Effectiveness of injectable risperidone long-acting therapy for schizophrenia: data from the US, Spain, Australia, and Belgium. Ann Gen Psychiatry. 2011 Apr 4;10:10. doi: 10.1186/1744-859X-10-10.CrossRefGoogle ScholarPubMed
Hoge, SK. Providing transition and outpatient services to the mentally ill released from correctional institutions. In: Greifinger, RB, ed. Public Health Behind Bars. New York: Springer; 2022:445–460.10.1007/978-1-0716-1807-3_30CrossRefGoogle Scholar
Ramsay, CE, Goulding, SM, Broussard, B, et al. Prevalence and psychosocial correlates of prior incarcerations in an urban, predominantly African-American sample of hospitalized patients with first-episode psychosis. J Am Acad Psychiatry Law. 2011; 39(1):57–64.Google Scholar
James, DJ, Glaze, LE. Mental health problems of prison and jail inmates. Bureau of Justice Statistics Special Report, NCJ 213600. September 2006.10.1037/e557002006-001CrossRefGoogle Scholar
Owen, EA, Perry, A, Scher, DP. Trauma in competency to stand trial evaluations. In: Javier, RA, Owen, EA, Maddux, JA, eds. Assessing Trauma in Forensic Contexts. Switzerland AG: Springer Nature; 2020:65–84.10.1007/978-3-030-33106-1_3CrossRefGoogle Scholar
Nicholson, RA, Kugler, KE. Competent and incompetent criminal defendants: a quantitative review of comparative research. Psychol Bull. 1991 May;109(3):355–370. doi: 10.1037/0033-2909.109.3.355.CrossRefGoogle ScholarPubMed
Pirelli, G, Gottdiener, WH, Zapf, PA. A meta-analytic review of competency to stand trial research. Psychol Pub Pol’y Law. 2011;17(1):1–53. doi: 10.1037/a0021713.CrossRefGoogle Scholar
Rosenfeld, B, Wall, BW. Psychopathology and competence to stand trial. Crim Justice Behav. 1998;25(4):443–462. doi: 10.1037/a0021713CrossRefGoogle Scholar
Mossman, D. Predicting restorability of incompetent criminal defendants. J Am Acad Psychiatry Law. 2007;35(1):34–43.Google ScholarPubMed
Cochrane, RE, Herbel, BL, Reardon, ML, Lloyd, KP. The Sell effect: Involuntary medication treatment is a “clear and convincing” success. Law Hum Behav. 2013;37(2): 107–116. doi: 10.1037/lhb0000003.CrossRefGoogle ScholarPubMed
Bergner, D. A major problem with compulsory mental health care is the medication. The New York Times. 2023.Google Scholar
Casey, DE. Pathophysiology of antipsychotic drug-induced movement disorders. J Clin Psychiatry. 2004;65(Suppl 9):25–28.Google ScholarPubMed
Newcomer, JW. Second-generation (atypical) antipsychotics and metabolic effects: a comprehensive literature review. CNS Drugs. 2005;19(Suppl 1):1–93. doi: 10.2165/00023210-200519001-00001.CrossRefGoogle ScholarPubMed
Fleischhacker, WW, Meise, U, Günther, V, Kurz, M. Compliance with antipsychotic drug treatment: influence of side effects. Acta Psychiatr Scand Suppl. 1994;382:11–15.Google ScholarPubMed
Kishimoto, T, Hagi, K, Kurokawa, S, Kane, JM, Correll, CU. Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia: a systematic review and comparative meta-analysis of randomised, cohort, and pre-post studies. Lancet Psychiatry. 2021 May;8(5):387–404. doi: 10.1016/S2215-0366(21)00039-0.CrossRefGoogle ScholarPubMed
Meyers, JM. How antipsychotics work in schizophrenia: A primer on mechanisms. CNS Spectrums, 2024 Dec 2;30(1):e6.10.1017/S1092852924002244CrossRefGoogle Scholar
Lim, WK, Chew, QH, He, YL, et al. Coprescription of mood stabilizers in schizophrenia, dosing, and clinical correlates: An international study. Hum Psychopharmacol. 2020;35:1–7. doi: 10.1002/hup.2752.CrossRefGoogle ScholarPubMed
Lähteenvuo, M, Taipale, H, Tanskanen, A, Mittendorfer-Rutz, E, Tiihonen, J. Effectiveness of pharmacotherapies for delusional disorder in a Swedish national cohort of 9076 patients. Schizophr Res. 2021 Feb;228:367–372. doi: 10.1016/j.schres.2021.01.015.CrossRefGoogle Scholar
González-Rodríguez, A, Seeman, MV. Differences between delusional disorder and schizophrenia: a mini narrative review. World J Psychiatry. 2022 May 19;12(5):683–692. doi: 10.5498/wjp.v12.i5.683.CrossRefGoogle ScholarPubMed
Muñoz-Negro, JE, Ibáñez-Casas, I, de Portugal, E, et al. A psychopathological comparison between delusional disorder and schizophrenia. Can J Psychiatry. 2018 Jan;63(1):12–19. doi: 10.1177/0706743717706347.CrossRefGoogle Scholar
Manschreck, TC, Khan, NL. Recent advances in the treatment of delusional disorder. Can J Psychiatry. 2006 Feb;51(2):114–119. doi: 10.1177/070674370 605100207.CrossRefGoogle ScholarPubMed
Miola, A, Salvati, B, Sambataro, F, Toffanin, T. Aripiprazole for the treatment of delusional disorders: a systematic review. Gen Hosp Psychiatry. 2020 Sep Oct;66:34–43. doi: 10.1016/j.genhosppsych.2020.06.012.CrossRefGoogle ScholarPubMed
Gunduz-Bruce, H, McMeniman, M, et al. Duration of untreated psychosis and time to treatment response for delusions and hallucinations. Am J Psychiatry. 2005 Oct;162(10):1966–1969. doi: 10.1176/appi.ajp.162.10.1966.CrossRefGoogle ScholarPubMed
Accessibility standard: WCAG 2.1 AA
Why this information is here
This section outlines the accessibility features of this content - including support for screen readers, full keyboard navigation and high-contrast display options. This may not be relevant for you.Accessibility Information
The HTML of this chapter
complies with version 2.1 of the
Web Content Accessibility Guidelines
(WCAG), covering newer accessibility requirements and improved
user experiences and achieves the intermediate
(AA)
level of WCAG compliance, covering a wider range of accessibility requirements.
Content Navigation
Table of contents navigation
Allows you to navigate directly to chapters, sections, or non‐text items through a linked table of contents, reducing the need for extensive scrolling.
Allows you to navigate directly to chapters, sections, or non‐text items through a linked table of contents, reducing the need for extensive scrolling.
Index navigation
Provides an interactive index, letting you go straight to where a term or subject appears in the text without manual searching.
Provides an interactive index, letting you go straight to where a term or subject appears in the text without manual searching.
Reading Order & Textual Equivalents
Single logical reading order
You will encounter all content (including footnotes, captions, etc.) in a clear, sequential flow, making it easier to follow with assistive tools like screen readers.
You will encounter all content (including footnotes, captions, etc.) in a clear, sequential flow, making it easier to follow with assistive tools like screen readers.
Short alternative textual descriptions
You get concise descriptions (for images, charts, or media clips), ensuring you do not miss crucial information when visual or audio elements are not accessible.
You get concise descriptions (for images, charts, or media clips), ensuring you do not miss crucial information when visual or audio elements are not accessible.
Full alternative textual descriptions
You get more than just short alt text: you have comprehensive text equivalents, transcripts, captions, or audio descriptions for substantial non‐text content, which is especially helpful for complex visuals or multimedia.
You get more than just short alt text: you have comprehensive text equivalents, transcripts, captions, or audio descriptions for substantial non‐text content, which is especially helpful for complex visuals or multimedia.
Visual Accessibility
Use of colour is not sole means of conveying information
You will still understand key ideas or prompts without relying solely on colour, which is especially helpful if you have colour vision deficiencies.
You will still understand key ideas or prompts without relying solely on colour, which is especially helpful if you have colour vision deficiencies.
Structural and Technical Features
ARIA roles provided
You gain clarity from ARIA (Accessible Rich Internet Applications) roles and attributes, as they help assistive technologies interpret how each part of the content functions.
You gain clarity from ARIA (Accessible Rich Internet Applications) roles and attributes, as they help assistive technologies interpret how each part of the content functions.