Increasing numbers of Americans are affected by serious mental illness and severe substance use disorders. While funding has increased for the treatment of these conditions in recent years, increases in service needs have outstripped resources. Further, too often those living with these conditions are incarcerated, held for inordinate periods without treatment in emergency departments, and/or relegated to the streets as part of the burgeoning numbers of homeless in the United States. These conditions require innovative approaches to care that should include integrated medical care and community resources to decrease isolation and to improve the response to crises as they occur. There are numerous opportunities already in place that, used appropriately, can improve outcomes for some of our most vulnerable people and will improve community living for all. This perspective describes available resources that can better address the mental health and substance use crisis facing the American people.

Treatment of patients suffering from schizophrenia in Austria: Treatment of patients with schizophrenia in the healthcare system is generally voluntary. This applies both to outpatient care provided by specialists in private practice, hospital outpatient clinics, or social psychiatric outpatient clinics and to inpatient care in hospitals. However, there is an exceptional situation in which the patient’s freedom of will is restricted by law. This is the case when acute danger to self or others caused by the disorder is present. With the involvement of the district court, the patient advocate, a possible adult representative, and an external expert, the patient’s freedom of movement can be restricted for a certain period of time to enable treatment. The acceptance of psychopharmacological therapy remains the patient’s decision in this situation, with the exception of explicit authorization by the court. Treatment under the consideration of proportionality, meaning that coercion is only applied in the case of an acute risk of severe bodily harm, is therefore possible for the majority of patients with schizophrenia. However, this does not mean that patients are able to connect to the care network in all cases. Some patients fail because the contact threshold is still too high. In order to reduce this, outreach care has been integrated into the existing services in many cases. These multi-professional teams often manage to establish contact with the patients and thus create a willingness to undergo treatment in order to counteract the long-term consequences, including complete social isolation and disintegration.

Anosognosia, commonly understood as a lack of insight, renders individuals with schizophrenia and schizoaffective disorder unable to understand that they are living with a disease, often resulting in a refusal to accept treatment. Typically, to impose involuntary commitment in an effort to obtain treatment, an individual must be a danger to others or themselves. Even if involuntary commitment is imposed, however, an individual may remain competent to refuse medication—despite symptoms of anosognosia and an inability to understand that they are ill. This article examines the existing legal theories of competency and informed consent and proposes a statutory definition of competency that encompasses the specific needs of people with anosognosia, while considering the significant interests at stake when taking away an individual’s right to choose or refuse treatment.

This article provides an overview of individuals with schizophrenia who become unhoused and explores current approaches to managing this severe illness in those who often do not want care or believe they need it. Individuals with schizophrenia and who are unhoused face numerous adverse consequences including premature mortality and increased rates of suicide. There is a dearth of research evidence demonstrating efficacy of the Housing First (HF) model and harm reduction approach in decreasing psychotic symptoms in individuals with schizophrenia. Ensuring medication adherence in individuals with psychosis, both housed and unhoused, is important to prevent delays in untreated psychosis and chronic deterioration.

The role of serotonin reuptake inhibitors (SSRIs) in treating psychiatric disorders has been a subject of heated debate since their introduction. Initially celebrated for their potential to address various mental health conditions during the late 1980s and 1990s, SSRIs have since faced significant scrutiny. Critics argue that their benefits may not be as substantial as initially believed. Over the past two decades, concerns have intensified with the emergence of boxed warnings about the risks associated with SSRIs, particularly regarding their link to increased suicidal thoughts in youth. This controversy is further complicated by questions about the integrity of early industry-sponsored trials and the reliability of subsequent National Institute of Mental Health (NIMH) trials. These issues have raised ongoing critical concerns about the effectiveness and safety of SSRIs, especially for treating a range of disorders in children and adolescents. This review seeks to critically appraise by presenting empirical evidence that addresses these controversies. It explores the validity of the monoamine theory, examines the fidelity of early and recent trials, and considers the broader implications for clinical practice. By answering specific, targeted questions, this article aims to clarify the ongoing debate and enhance the understanding of SSRIs’ role in mental health treatment. The goal is to support clinicians in making more informed decisions when prescribing these medications and to ensure consideration of the balance between potential benefits and risks for young patients with mental health disorders.

Although psychopathic personality traits are widely reported to be related to reduced reactivity to emotion-eliciting situations, findings are not consistent. It has been argued that these differences could be related to variations in the way psychopathy is measured. To examine whether measurement variance resulting from the use of clinical assessment versus self-report assessment could be driving such differences, this systematic review and meta-analysis investigated the comparability of relations between psychopathic traits and responsiveness to emotion-inducing tasks for clinical versus self-report measures. The systematic review resulted in eight studies and 131 effect sizes, which included studies of emotion categorization, emotion regulation, decision-making, and executive functioning tasks. Robust Variance Estimation correlated effects models revealed no significant differences between effect sizes for clinical (PCL-R) versus self-report (PPI, SRP, and LSRP) assessment-based psychopathic traits and emotion tasks. Despite the small number of studies that included both clinical and self-report assessments of psychopathy, these results do not provide any evidence for an assessment-based difference in correlations with emotional responsiveness across tasks. The findings also show no associations between scores on emotional responsiveness and indices of psychopathy. Future research on emotional responsiveness in psychopathy should include both assessment types to be able to increase the research basis for the comparison.

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.

People with serious mental illness (SMI) are over-represented throughout the US criminal justice system. To address this issue, forensic assertive community treatment has recently emerged as a best-practice intervention. Also known as forensic ACT, ForACT, or most commonly as “FACT,” forensic assertive community treatment is an adaptation of the assertive community treatment (ACT) model. Unlike ACT, however, FACT is purposefully designed to prevent arrest and incarceration among people with SMI who have histories of involvement with the criminal justice system (i.e., “justice-involved” individuals). Although FACT was recognized as a best practice by the Substance Abuse and Mental Health Services Administration (SAMHSA) in 2019, FACT teams vary widely in their structure and daily operations. This lack of a standard FACT model continues to impede FACT program implementation and outcomes research. This article begins with a review of FACT origins, followed by a discussion of what we know (and do not know) about FACT operation and effectiveness. Based on the authors’ experience, the article then discusses key components of FACT and concludes with a discussion of current challenges and research recommendations for FACT model development.

Glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) receptor agonists (RAs) mimic naturally occurring GLP-1 and GIP and are highly effective anti-diabetic and anti-obesity agents. In addition to their robust acute and long-term effects on weight, metabolism, and blood pressure, these agents also reduce cardiovascular mortality as well as stroke risk and associated consequences. A replicated and convergent body of preclinical evidence also indicates that incretin receptor agonists activate molecular effectors critical to neuroplasticity, neuroprotection, and anti-apoptosis. Herein, we propose that GLP-1 RAs and GIP RAs are promising transdiagnostic mechanistically informed therapeutics in the treatment and prevention of multiple domains of psychopathology, including general cognitive, reward, and motivation systems and mental disorders. Major neurocognitive disorders (eg, Alzheimer’s Disease, Parkinson’s Disease), alcohol and substance use disorders, traumatic brain injury, and depressive disorders are near-term therapeutic targets. In addition, GLP-1 RAs and GIP RAs have robust effects on comorbidities that differentially affect persons with mental disorders (eg, cardiovascular, cerebrovascular, and metabolic disorders) and psychotropic drug-related weight gain.

Attention-deficit/hyperactivity disorder (ADHD) is a highly heterogeneous disorder for which treatment personalization is essential. Stimulant medications are the first-line option for ADHD management due to their high efficacy. While the choice of stimulant is limited to methylphenidate or amphetamine, there are numerous formulation options each associated with different potential benefits and restrictions. The goal is to deliver a stimulant medication that provides an even, continuous control of symptoms tailored to the patient’s symptoms and lifestyle. This article reviews the technologies used to deliver stimulants and the impact their characteristics have on the pharmacokinetic profiles, dosing regimens, and flexibility of the medication. The aim was to help clinicians in their treatment decision-making process and provide patients with effective and individualized management of their ADHD symptoms.

Tardive dyskinesia (TD) is a potentially irreversible movement disorder induced by dopamine receptor-blocking agents, including antipsychotics. Despite progress in antipsychotic medications, TD remains widely prevalent even in the era of second-generation antipsychotics. Early detection is critical for preventing irreversible damage and minimizing the disorder’s impact on patients’ daily lives. Risk factors for TD include advanced age, female sex, medical comorbidities, and prolonged use of dopamine receptor-blocking agents (DRBAs). Effective screening for TD should incorporate evidence-based screening techniques such as the Abnormal Involuntary Movement Scale (AIMS) and informal methods to capture a comprehensive view of TD’s severity and impact. Combining these approaches allows for a thorough assessment of both healthcare practitioner-perceived severity and patient-reported effects on daily life. Modern treatment options, including vesicular monoamine transporter 2 (VMAT2) inhibitors like valbenazine and deutetrabenazine, have demonstrated significant efficacy and safety in clinical trials. Approved by the FDA in 2017, these medications enable continued psychiatric care while managing TD symptoms. Long-term studies support their sustained efficacy and safety, underscoring the importance of individualized, evidence-based treatment plans to improve patient outcomes.

Major depressive disorder (MDD) is a disabling condition affecting children, adolescents, and adults worldwide. A high proportion of patients do not respond to one or more pharmacological treatments and are said to have treatment-resistant or difficult-to-treat depression. Inadequate response to current treatments could be due to medication nonadherence, inter-individual variability in treatment response, misdiagnosis, diminished confidence in treatment after many trials, or lack of selectivity. Demonstrating an adequate response in the clinical trial setting is also challenging. Patients with depression may experience non-specific treatment effects when receiving placebo in clinical trials, which may contribute to inadequate response. Studies have attempted to reduce the placebo response rates using adaptive designs such as sequential parallel comparison design. Despite some of these innovations in study design, there remains an unmet need to develop more targeted therapeutics, possibly through precision psychiatry-based approaches to reduce the number of treatment failures and improve remission rates. Examples of precision psychiatry approaches include pharmacogenetic testing, neuroimaging, and machine learning. These approaches have identified neural circuit biotypes of MDD that may improve precision if they can be feasibly bridged to real-world clinical practice. Clinical biomarkers that can effectively predict response to treatment based on individual phenotypes are needed. This review examines why current treatment approaches for MDD often fail and discusses potential benefits and challenges of a more targeted approach, and suggested approaches for clinical studies, which may improve remission rates and reduce the risk of relapse, leading to better functioning in patients with depression.