Cargando…

Receptor-Independent Therapies for Forensic Detainees with Schizophrenia–Dementia Comorbidity

Forensic institutions throughout the world house patients with severe psychiatric illness and history of criminal violations. Improved medical care, hygiene, psychiatric treatment, and nutrition led to an unmatched longevity in this population, which previously lived, on average, 15 to 20 years shor...

Descripción completa

Detalles Bibliográficos
Autores principales: Sfera, Adonis, Andronescu, Luminita, Britt, William G., Himsl, Kiera, Klein, Carolina, Rahman, Leah, Kozlakidis, Zisis
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10647468/
https://www.ncbi.nlm.nih.gov/pubmed/37958780
http://dx.doi.org/10.3390/ijms242115797
_version_ 1785135114225713152
author Sfera, Adonis
Andronescu, Luminita
Britt, William G.
Himsl, Kiera
Klein, Carolina
Rahman, Leah
Kozlakidis, Zisis
author_facet Sfera, Adonis
Andronescu, Luminita
Britt, William G.
Himsl, Kiera
Klein, Carolina
Rahman, Leah
Kozlakidis, Zisis
author_sort Sfera, Adonis
collection PubMed
description Forensic institutions throughout the world house patients with severe psychiatric illness and history of criminal violations. Improved medical care, hygiene, psychiatric treatment, and nutrition led to an unmatched longevity in this population, which previously lived, on average, 15 to 20 years shorter than the public at large. On the other hand, longevity has contributed to increased prevalence of age-related diseases, including neurodegenerative disorders, which complicate clinical management, increasing healthcare expenditures. Forensic institutions, originally intended for the treatment of younger individuals, are ill-equipped for the growing number of older offenders. Moreover, as antipsychotic drugs became available in 1950s and 1960s, we are observing the first generation of forensic detainees who have aged on dopamine-blocking agents. Although the consequences of long-term treatment with these agents are unclear, schizophrenia-associated gray matter loss may contribute to the development of early dementia. Taken together, increased lifespan and the subsequent cognitive deficit observed in long-term forensic institutions raise questions and dilemmas unencountered by the previous generations of clinicians. These include: does the presence of neurocognitive dysfunction justify antipsychotic dose reduction or discontinuation despite a lifelong history of schizophrenia and violent behavior? Should neurolipidomic interventions become the standard of care in elderly individuals with lifelong schizophrenia and dementia? Can patients with schizophrenia and dementia meet the Dusky standard to stand trial? Should neurocognitive disorders in the elderly with lifelong schizophrenia be treated differently than age-related neurodegeneration? In this article, we hypothesize that gray matter loss is the core symptom of schizophrenia which leads to dementia. We hypothesize further that strategies to delay or stop gray matter depletion would not only improve the schizophrenia sustained recovery, but also avert the development of major neurocognitive disorders in people living with schizophrenia. Based on this hypothesis, we suggest utilization of both receptor-dependent and independent therapeutics for chronic psychosis.
format Online
Article
Text
id pubmed-10647468
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-106474682023-10-31 Receptor-Independent Therapies for Forensic Detainees with Schizophrenia–Dementia Comorbidity Sfera, Adonis Andronescu, Luminita Britt, William G. Himsl, Kiera Klein, Carolina Rahman, Leah Kozlakidis, Zisis Int J Mol Sci Hypothesis Forensic institutions throughout the world house patients with severe psychiatric illness and history of criminal violations. Improved medical care, hygiene, psychiatric treatment, and nutrition led to an unmatched longevity in this population, which previously lived, on average, 15 to 20 years shorter than the public at large. On the other hand, longevity has contributed to increased prevalence of age-related diseases, including neurodegenerative disorders, which complicate clinical management, increasing healthcare expenditures. Forensic institutions, originally intended for the treatment of younger individuals, are ill-equipped for the growing number of older offenders. Moreover, as antipsychotic drugs became available in 1950s and 1960s, we are observing the first generation of forensic detainees who have aged on dopamine-blocking agents. Although the consequences of long-term treatment with these agents are unclear, schizophrenia-associated gray matter loss may contribute to the development of early dementia. Taken together, increased lifespan and the subsequent cognitive deficit observed in long-term forensic institutions raise questions and dilemmas unencountered by the previous generations of clinicians. These include: does the presence of neurocognitive dysfunction justify antipsychotic dose reduction or discontinuation despite a lifelong history of schizophrenia and violent behavior? Should neurolipidomic interventions become the standard of care in elderly individuals with lifelong schizophrenia and dementia? Can patients with schizophrenia and dementia meet the Dusky standard to stand trial? Should neurocognitive disorders in the elderly with lifelong schizophrenia be treated differently than age-related neurodegeneration? In this article, we hypothesize that gray matter loss is the core symptom of schizophrenia which leads to dementia. We hypothesize further that strategies to delay or stop gray matter depletion would not only improve the schizophrenia sustained recovery, but also avert the development of major neurocognitive disorders in people living with schizophrenia. Based on this hypothesis, we suggest utilization of both receptor-dependent and independent therapeutics for chronic psychosis. MDPI 2023-10-31 /pmc/articles/PMC10647468/ /pubmed/37958780 http://dx.doi.org/10.3390/ijms242115797 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Hypothesis
Sfera, Adonis
Andronescu, Luminita
Britt, William G.
Himsl, Kiera
Klein, Carolina
Rahman, Leah
Kozlakidis, Zisis
Receptor-Independent Therapies for Forensic Detainees with Schizophrenia–Dementia Comorbidity
title Receptor-Independent Therapies for Forensic Detainees with Schizophrenia–Dementia Comorbidity
title_full Receptor-Independent Therapies for Forensic Detainees with Schizophrenia–Dementia Comorbidity
title_fullStr Receptor-Independent Therapies for Forensic Detainees with Schizophrenia–Dementia Comorbidity
title_full_unstemmed Receptor-Independent Therapies for Forensic Detainees with Schizophrenia–Dementia Comorbidity
title_short Receptor-Independent Therapies for Forensic Detainees with Schizophrenia–Dementia Comorbidity
title_sort receptor-independent therapies for forensic detainees with schizophrenia–dementia comorbidity
topic Hypothesis
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10647468/
https://www.ncbi.nlm.nih.gov/pubmed/37958780
http://dx.doi.org/10.3390/ijms242115797
work_keys_str_mv AT sferaadonis receptorindependenttherapiesforforensicdetaineeswithschizophreniadementiacomorbidity
AT andronesculuminita receptorindependenttherapiesforforensicdetaineeswithschizophreniadementiacomorbidity
AT brittwilliamg receptorindependenttherapiesforforensicdetaineeswithschizophreniadementiacomorbidity
AT himslkiera receptorindependenttherapiesforforensicdetaineeswithschizophreniadementiacomorbidity
AT kleincarolina receptorindependenttherapiesforforensicdetaineeswithschizophreniadementiacomorbidity
AT rahmanleah receptorindependenttherapiesforforensicdetaineeswithschizophreniadementiacomorbidity
AT kozlakidiszisis receptorindependenttherapiesforforensicdetaineeswithschizophreniadementiacomorbidity