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.

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.

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.

This chapter explores the complex and controversial path of MDMA-assisted therapy (MDMA-AT) for treating post-traumatic stress disorder (PTSD) and other behavioral disorders. It covers MDMA’s history from research to recreation to medicine, the pivotal trials, and the challenges faced by researchers. Despite recent setbacks for the clinical application of MDMA, the chapter argues that it holds potential for transforming psychiatry and discusses the uncertain future amidst ongoing debates over ethics, methodology, and political influence.

Assisted Outpatient Treatment (AOT) is a controversial civil court program wherein a judge orders a person with severe mental illness to adhere to an outpatient treatment plan designed to improve treatment adherence, prevent relapse and dangerous deterioration. Several states, including California and New York, have recently promoted use of AOT to try to address high rates of homelessness among person with severe mental illness. Under AOT, clinicians treating these patients must balance the ethical principles of patient autonomy and beneficence, and employ AOT only when previous treatment failed as a result of treatment non-adherence. However, some critics of AOT argue that not only is it coercive and ineffective but that the court mandate to adhere to prescribed medications, usually antipsychotic medications, compels AOT recipients to take ineffective and even harmful medications. This article examines the assertion of these critics and reviews the evidence of antipsychotic effectiveness and potential harms in treating psychotic disorders under a civil court order.

The history of Italian general psychiatry and forensic psychiatry over the last 50 years has been unique in the European and Western healthcare landscape. Western politicians often visit Italy to observe the successful community-based systems that have developed in that country.

This article represents a first step toward a necessary attempt, to explore how specific political decisions, such as the Italian one, have produced positive outcomes for patients with psychotic disorders, outcomes not observed in many Western countries, which are instead grappling with negative outcomes such as the complicated management of homelessness and the incarceration of people who would instead require psychiatric care.

In its historical context, the 1978 decision to abandon the asylum tradition in favor of socialization for patients living with severe mental disorders represented a difficult choice. This choice led to inevitable critical issues, which today are still not completely dormant.

This choice has also, undoubtedly, restored dignity to people living with serious mental illness, even when that person commits a crime.

To understand these changes, it is appropriate to mention the regulations that finally led to Law number 180 of 1978, which decreed the closure of psychiatric hospitals (Ospedale Psichiatrico) throughout Italy and continued after 2015 with the closure of high-security psychiatric hospitals (Ospedale Psichiatrico Giudiziario) as well.

Culturally, much has changed throughout this time in assistance to the mentally ill in Europe.

Epidemiological data indicates a rising prevalence of autism spectrum disorder (ASD) among eight-year-old children, with rates increasing from 1 in 44 to 1 in 36 between 2022 and 2023. This growing prevalence poses significant challenges in achieving accurate diagnoses, particularly due to comorbid conditions and diagnostic overshadowing. Certain subgroups—such as females with ASD, individuals with high cognitive abilities, and ethnic minorities—remain at heightened risk of underdiagnosis. Diagnostic tools like the Autism Diagnostic Observation Schedule (ADOS-2) have limitations, particularly in clinical settings where gender biases and cultural differences in symptom presentation can complicate accurate assessment. Moreover, rural areas face additional burdens due to limited access to care, further exacerbating diagnostic challenges. The review underscores the necessity for improved screening and diagnostic methods tailored to diverse populations, acknowledging the current limitations of existing tools. It also highlights significant barriers such as workforce shortages and lengthy wait times for evaluations. Emphasizing the importance of clinician education and targeted diagnostic approaches, the review calls for attention to cultural and gender differences in ASD evaluation.