In an earlier study, improvement of dietary status with food supplements led to a reduction in antisocial behavior among prisoners. Based on these earlier findings, a study of the effects of food supplements on aggression, rule-breaking, and psychopathology was conducted among young Dutch prisoners. Two hundred and twenty-one young adult prisoners (mean age=21.0, range 18-25 years) received nutritional supplements containing vitamins, minerals, and essential fatty acids or placebos, over a period of 1-3 months. As in the earlier (British) study, reported incidents were significantly reduced (P=.017, one-tailed) in the active condition (n=115), as compared with placebo (n=106). Other assessments, however, revealed no significant reductions in aggressiveness or psychiatric symptoms. As the incidents reported concerned aggressive and rule-breaking behavior as observed by the prison staff, the results are considered to be promising. However, as no significant improvements were found in a number of other (self-reported) outcome measures, the results should be interpreted with caution.

Forensic psychiatry in Europe is a specialty primarily concerned with individuals who have either offended or present a risk of doing so, and who also suffer from a psychiatric condition. These mentally disordered offenders (MDOs) are often cared for in secure psychiatric environments or prisons. In this guidance paper we first present an overview of the field of forensic psychiatry from a European perspective. We then present a review of the literature summarising the evidence on the assessment and treatment of MDOs under the following headings: The forensic psychiatrist as expert witness, risk, treatment settings for mentally disordered offenders, and what works for MDOs. We undertook a rapid review of the literature with search terms related to: forensic psychiatry, review articles, randomised controlled trials and best practice. We searched the Medline, Embase, PsycINFO, and Cochrane library databases from 2000 onwards for adult groups only. We scrutinised publications for additional relevant literature, and searched the websites of relevant professional organisations for policies, statements or guidance of interest. We present the findings of the scientific literature as well as recommendations for best practice drawing additionally from the guidance documents identified. We found that the evidence base for forensic-psychiatric practice is weak though there is some evidence to suggest that psychiatric care produces better outcomes than criminal justice detention only. Practitioners need to follow general psychiatric guidance as well as that for offenders, adapted for the complex needs of this patient group, paying particular attention to long-term detention and ethical issues.

Many forensic psychiatric inpatients have difficulties regulating aggressive behavior. Evidence of effective aggression treatments is limited. We designed and investigated the effectiveness of a transdiagnostic application of a virtual reality aggression prevention training (VRAPT). In this randomized controlled trial at four Dutch forensic psychiatric centers, 128 inpatients with aggressive behavior were randomly assigned to VRAPT (N = 64) or waiting list control group (N = 64). VRAPT consisted of 16 one-hour individual treatment sessions twice a week. Assessments were done at baseline, post-treatment and at 3-month follow-up. Primary outcome measures were aggressive behavior observed by staff and self-reported aggressive behavior. Analysis was by intention to treat. This trial was registered in the Dutch Trial Register (NTR, TC = 6340). Participants were included between 1 March 2017, and 31 December 2018. Compared to waiting list, VRAPT did not significantly decrease in self-reported or observed aggressive behavior (primary outcomes). Hostility, anger control, and non-planning impulsiveness improved significantly in the VRAPT group compared to the control group at post-treatment. Improvements were not maintained at 3-month follow-up. Results suggest that VRAPT does not decrease aggressive behavior in forensic inpatients. However, there are indications that VRAPT temporarily influences anger control skills, impulsivity and hostility.

Individuals with aggression regulation disorders tend to attribute hostility to others in socially ambiguous situations. Previous research suggests that this "hostile attribution bias" is a powerful cause of aggression. Facial expressions form important cues in the appreciation of others' intentions. Furthermore, accurate processing of facial expressions is fundamental to normal socialization. However, research on interpretation biases in facial affect is limited. It is asserted that a hostile interpretation bias (HIB) is likely to be displayed by individuals with an antisocial (ASPD) and borderline personality disorder (BPD) and probably also with an intermittent explosive disorder (IED). However, there is little knowledge to what extent this bias is displayed by each of these patient groups. The present study investigated whether a HIB regarding emotional facial expressions was displayed by forensic psychiatric outpatients (FPOs) and whether it was associated with ASPD and BPD in general or, more specifically, with a disposition to react with pathological aggression. Participants of five different groups were recruited: FPOs with ASPD, BPD, or IED, non-forensic patients with BPD (nFPOs-BPD), and healthy, non-aggressive controls (HCs). Results suggest that solely FPOs with ASPD, BPD, or IED exhibit a HIB regarding emotional facial expressions. Moreover, this bias was associated with type and severity of aggression, trait aggression, and cognitive distortions. The results suggest that a HIB regarding facial expressions is an important characteristic of pathological aggressive behavior. Interventions that modify the HIB might help to reduce the recurrence of aggression. Aggr. Behav. 43:386-397, 2017. © 2017 Wiley Periodicals, Inc.