OBJECTIVE: To review and highlight the opportunities and challenges of pharmacologic advances in the use of antipsychotics for the state hospital system. METHODS: A critical review was performed of studies published either as articles or abstracts, on the use of novel antipsychotics, particularly as they relate to the patient population within the state mental hospital system. FINDINGS: The recent availability of new antipsychotic medications within state facilities has resulted in more progressive treatment, reduced recidivism (and consequently cost savings), and preliminary evidence of preferential and superior treatment response in specific patient subgroups (e.g., those with aggression). At the same time, inpatient pharmacy budget increases and uncertainty in guiding the use of novel antipsychotics have influenced the availability of these agents in state hospitals. CONCLUSIONS: State hospital services have, by and large, embraced the developments in pharmacotherapy of schizophrenia. Optimal use of these new agents in this population requires additional information on their relative efficacy in specific patient subgroups.
THE DEVELOPMENT OF THE MODERN CARE AND TREATMENT OF THE INSANE, AS ILLUSTRATED BY THE STATE HOSPITAL SYSTEM OF NEW YORK