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

Heiner Fangerau,Janusz Heitzman,Hildegard Winkler,Rudolf Slamanig,Marco Picchioni,Johannes Wancata,Cristina Crocamo,Andreas Reisegger,Hans Joachim Salize,Giuseppe Carrà,Inga Markiewicz,Giovanni de Girolamo

doi:10.3389/fpsyt.2021.618860

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.

Highlights

One in 100 of the population will develop a schizophrenia spectrum disorder (SSD) during their lifetime
A recently published umbrella review of nonpharmacological violence reduction strategies across psychiatric settings identified five reviews, but none in forensic psychiatric services [20]. All these findings indicate that studies of nonpharmacological interventions for violence prevention are scarce for SSD patients in forensic settings
This matches with the recently published paper by Howner et al [38] who reported that they independent of type of mental diagnosis treated in forensic psychiatry found no systematic review with a low risk of bias, and only four systematic reviews having a moderate risk of bias

Summary

Introduction

One in 100 of the population will develop a schizophrenia spectrum disorder (SSD) during their lifetime. While some schizophrenia sufferers recover after some episodes, others have numerous relapses or develop a chronic course. Among those with a chronic course frequently impairments of the cognitive and social skills can be observed. This can lead to the inability of independent housing or to difficulties in working [2, 3]. 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

Results

Discussion

Conclusion