Special consideration is required when prescribing antipsychotic drugs for patients with an existing diagnosis of breast cancer. The package inserts of all approved antipsychotics contain precautions regarding their administration in this patient group. These drugs are well known to elevate serum prolactin levels to varying degrees. Overexpression of the prolactin receptor is seen in more than 95% of human breast cancers. Many genes that are activated by the prolactin receptor are associated with tumorigenesis and cancer cell proliferation. The authors discuss the pathophysiology, clinical implications, and pertinent preclinical data and make specific recommendations regarding the use of antipsychotics in patients with breast cancer.

Purpose/Background: Antipsychotic drugs are well established to alter circulating prolactin levels by blocking dopamine D 2 receptors in the pituitary. Prolactin activates many genes important in the development of breast cancer. Prior studies have found an association with antipsychotic use and risk of breast cancer.

Pathological fixation -preoccupation with a person or a cause that is accompanied by deterioration in social and occupational functioning -has been found to precede most cases of targeted violence. It is clinically observed and theorized to have three different cognitive-affective drivers: delusion, obsession, or extreme overvalued belief. Each driver is explained, and case examples are provided in the context of threat assessment. Extreme overvalued belief as a new concept is discussed in detail, both its historical provenance and its demarcation from delusions and obsessions. Threat management for each separate cognitive-affective driver is briefly summarized, based upon current clinical findings and research. Emphasis is placed upon understanding both the categorical and dimensional nature (intensity) of these cognitive-affective drivers, and suggested guidelines are offered for the assessment of such in a clinical examination by a forensic psychiatrist or psychologist. | INTRODUCTIONPathological fixation -preoccupation with a particular person or cause that is accompanied by deterioration in

Extreme overvalued beliefs (EOB) are rigidly held, non-deusional beliefs that are the motive behind most acts of terrorism and mass shootings. EOBs are differentiated from delusions and obsessions. The concept of an overvalued idea was first described by Wernicke and later applied to terrorism by McHugh. Our group of forensic psychiatrists (Rahman, Resnick, Harry) refined the definition as an aid in the differential diagnosis seen in acts of violence. The form and content of EOBs is discussed as well as group effects, conformity, and obedience to authority. Religious cults such as The People’s Temple, Heaven’s Gate, Aum Shinrikyo, and Islamic State (ISIS) and conspiracy beliefs such as assassinations, moon-hoax, and vaccine-induced autism beliefs are discussed using this construct. Finally, some concluding thoughts on countering violent extremism, including its online presence is discussed utilizing information learned from online eating disorders and consumer experience.

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