A Systematic Review of Non-pharmacological Strategies to Reduce the Risk of Violence in Patients With Schizophrenia Spectrum Disorders in Forensic Settings

Abstract

Background: The purpose of this systematic review is to systematically investigate which non-pharmacological interventions are effective in reducing violence risk among patients with schizophrenia spectrum disorders (SSD) in forensic settings.Methods: Six electronic data bases were searched. Two researchers independently screened 6,003 abstracts resulting in 143 potential papers. These were analyzed in detail by two independent researchers yielding 10 articles that could be used.Results: Of the 10 articles, four were non-randomized controlled trials, three were pre-post studies without controls, and one was observational. Only two studies applied a randomized controlled trial design. Cognitive behavioral treatment programs were investigated in three studies. A broad range of other interventions were studied. Often outcome measures were specific to each study and sample sizes were small. Frequently, important methodological information was missing from the papers. It was not possible to carry out a meta-analysis due to the heterogeneity of the study designs and outcome measures.Conclusion: Because of methodological limitations it is difficult to draw firm conclusions about the effectiveness of non-pharmacological interventions to reduce the risk of violence in patents with SSD in forensic psychiatry settings. Studies applying better methods in terms of study design, sample sizes and outcome measures are urgently needed.

Cognitive behavioural therapy plus standard care versus standard care for persistent aggressive behaviour or agitation in people with schizophrenia

“…However, we cannot compare our results with this overview since it is not focussed on severe mental illness and the intervention studies included non-randomised as well as randomised controlled trials. A recent review (Slamaning 2021) includes three studies under the heading of Cognitive-Behavioral Treatment Program, but two of them are not randomised and then do not fit our inclusion criteria and the third is the Cullen 2012 study already included in this review. A meta-analysis focussing on the e ectiveness of psychological and psychosocial interventions for forensic mental health inpatients (McIntosh 2021) quotes several studies which focus on aggression, however, the only study fitting our inclusion criteria is again Cullen 2012.…”

Differences Between Readmitted and Non-readmitted Women in an Italian Forensic Unit: A Retrospective Study

“…As for significant outcomes in forensic services, the average length of stay of these patients in forensic hospitals is 3years, but the death rate, the readmission rate, and the reoffending rate show substantially high diversity worldwide ( Fazel et al, 2016 ). Comparisons between international studies are problematic because of variations in many essential specifics, including settings, laws, descriptions of populations, outcome measures, and follow-up periods ( Lund et al, 2012 ; Di Lorito et al, 2017 ; Mandarelli et al, 2019 ; Slamanig et al, 2021 ). Notwithstanding this, there is some evidence that patients discharged from forensic psychiatric services have lower rates of criminal recidivism than comparative groups ( Hayes et al, 2014 ; Charette et al, 2015 ; Norko et al, 2016 ).…”