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ObjectiveA number of studies have demonstrated the anti-aggressive properties of clozapine in schizophrenia and its positive effect in borderline personality disorder. There is no published literature on the treatment of antisocial personality disorder (ASPD) with clozapine. We present a case series of 7 patients with primary ASPD and high psychopathic traits treated with clozapine, having a significant history of serious violence and currently detained in a UK based high-security hospital.MethodsA retrospective review of case notes was carried out to formulate Clinical Global Impression (CGI) scores and record incidents of violence and aggression. Effect on specific symptom domains (cognitive-perceptual, impulsive-behavioural dyscontrol, affective dysregulation) was also noted. Metabolic parameters and serum clozapine levels were also sampled.ResultsAll 7 patients showed significant improvement on clozapine. It was shown to benefit all symptom domains, especially impulsive behavioral dyscontrol and anger. The number of violent incidents committed by 6 of the 7 patients reduced significantly, and all patients’ risk of violence reduced. Clozapine serum levels for 6 of the 7 patients were in the range 150–350 ng/mL.ConclusionClozapine is of benefit in reducing the clinical severity of ASPD. It improved all symptom domains, especially impulsive-behavioral dyscontrol and anger, and reduced levels of aggression and violence, especially at lower doses (serum levels <350 ng/m). To our knowledge, this is the first account of clozapine treatment in patients with ASPD and high psychopathy.

The purpose of this paper is to investigate the prevalence of stress and burnout among forensic mental health professionals (FMH). Design/methodology/approach A systematic review of the available literature accessed by relevant databases was conducted. Findings This study concluded that FMH suffer from moderate levels of both stress and burnout. There is insufficient evidence to establish that they suffer from higher levels of stress than their non-forensic colleagues. Interventions such as PSI (psychosocial intervention) training have been reported to demonstrate an improvement in staff knowledge and attitudes toward patients, whilst reducing burnout. Practical implications Stress in FMH is a cause of concern. Conclusions drawn are applicable only to nursing staff as other professions were not adequately represented. As most studies used the burnout scores, results were directly comparable. Further

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