Psychotic disorders

Abstract There are high rates of psychotic disorders in jails and prisons. Schizophrenia spectrum disorders and substance-induced psychosis are common conditions. Clinical presentations can be complex, and careful assessment and a well-reasoned psychotic disorder diagnosis is the foundation of a sound treatment approach. Correctional systems vary widely in terms of treatment resources, access to psychiatric hospital beds, and legal provisions for involuntary treatment. Evidence-informed treatment approaches can be drawn from established community treatment guidelines, but in practice, the provision of treatment for incarcerated persons presents significant clinical, security, and administrative challenges. Most jails and prisons provide screening, assessment, and treatment resources for pharmacological intervention. This ranges from rudimentary provisions to a systematic approach with a full multidisciplinary care team. Evidence-informed pharmacological treatment involves antipsychotic medication as the primary treatment for most psychotic disorders. Key clinical treatment considerations adapted from community treatment guidelines can be applied to incarcerated persons with psychotic disorders. For better resourced correctional systems, strong scientific evidence exists for the configuration of treatment interventions that reduce recidivism in incarcerated persons with psychotic disorders. These treatment configurations address mental health recovery and recidivism using the risk–need–responsivity principles and target criminogenic risk factors.