Abstract
The purpose was to systematically investigate which pharmacological strategies are effective to reduce the risk of violence among patients with Schizophrenia Spectrum Disorders (SSD) in forensic settings. For this systematic review six electronic data bases were searched. Two researchers independently screened the 6,003 abstracts resulting in 143 potential papers. These were then analyzed in detail by two independent researchers. Of these, 133 were excluded for various reasons leaving 10 articles in the present review. Of the 10 articles included, five were merely observational, and three were pre-post studies without controls. One study applied a matched case-control design and one was a non-randomized controlled trial. Clozapine was investigated most frequently, followed by olanzapine and risperidone. Often, outcome measures were specific to the study and sample sizes were small. Frequently, relevant methodological information was missing. Due to heterogeneous study designs and outcomes meta-analytic methods could not be applied. Due to substantial methodological limitations it is difficult to draw any firm conclusions about the most effective pharmacological strategies to reduce the risk of violence in patents with SSD in forensic psychiatry settings. Studies applying more rigorous methods regarding case-definition, outcome measures, sample sizes, and study designs are urgently needed.
Highlights
The World Health Organization (WHO), in its report on violence and health defined violence as “the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation”.1 In this paper, we used the WHO definition of violence as orientation, but did not focus on violence against oneself.There are links between a range of mental disorders and the risk of violence
Three studies were conducted in the United States, two in Canada, two in the United Kingdom, two in Germany, and one in Croatia
Because of the lack of good quality data and the methodological limitations of the studies that are available so far, it is not possible to draw any firm conclusions about the effectiveness of psychotropic medicines to reduce the risk of violence in patients with Spectrum Disorders (SSD) in forensic settings
Summary
The World Health Organization (WHO), in its report on violence and health defined violence as “the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation”.1 In this paper, we used the WHO definition of violence as orientation, but did not focus on violence against oneself.There are links between a range of mental disorders and the risk of violence. A systematic review and meta-analysis[2] on 20 original studies demonstrated a clear association between schizophrenia, substance use disorders and violence. They reported an OR of 2.1 (95% CI 1.7– 2.7) for those with schizophrenia only compared to the general public, with that risk rising markedly when substance use disorder was present (OR 8.9, 95% CI 5.4–14.7). The purpose was to systematically investigate which pharmacological strategies are effective to reduce the risk of violence among patients with Schizophrenia Spectrum Disorders (SSD) in forensic settings. Studies applying more rigorous methods regarding case-definition, outcome measures, sample sizes, and study designs are urgently needed
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