Heval Özgen, Renske Spijkerman, Wim van den Brink and Vincent Hendriks contributed equally to this paper.

Objectives: We examine the use of combination long-acting injectable (LAI) antipsychotic medication for adolescents with severe psychosis and aggression. We discuss benefits and risks with this approach, for a highly challenging small group of young people. Methods: A clinical summary is given of three adolescents admitted to a secure adolescent forensic inpatient unit, and the literature is reviewed. Results: In these adolescents with severe psychosis, aggression and violent offending, combination LAI antipsychotics effectively treated psychosis and enabled transfer to less restrictive settings. Brief Psychiatric Rating Scale (BPRS) scores decreased significantly with treatment, without any severe adverse effects. Conclusions: Combination LAI antipsychotics may be an effective treatment for adolescents with severe psychosis and aggression where clozapine is not a realistic therapeutic option. Close monitoring for side-effects, clear documentation of clinical reasoning and appropriate safeguards are important.

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Serious mental illness was a significant predictor of rapid reincarceration in young offenders. Treatment improved community survival. The findings highlight the need for optimal psychiatric treatment and post-release care for young offenders with mental illness.