Mapping Systematic Reviews on Forensic Psychiatric Care: A Systematic Review Identifying Knowledge Gaps

Howner, Katarina; Andiné, Peter; Bertilsson, Göran; Hultcrantz, Monica; Lindström, Eva; Mowafi, Frida; Snellman, Alexandra; Hofvander, Björn

doi:10.3389/fpsyt.2018.00452

Cited by 43 publications

(43 citation statements)

References 16 publications

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“…The professional skills and interventions speci c to preventing and managing violence and aggression in hospital are increasingly the subject of development and training, but research in this area is sparse. Recent Cochrane reviews and systematic reviews found no studies that met inclusion criteria, much evidence for adverse effects and a lack of focus upon non-pharmacological methods for containment of violence or self-harm in people with serious mental illness (3,4,5).…”

Section: Rationalementioning

confidence: 99%

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A tool to evaluate proportionality and necessity in the use of restrictive practices in forensic mental health settings: The DRILL tool (Dundrum Restriction, Intrusion and Liberty Ladders).

Kennedy

Mullaney

McKenna

et al. 2020

Preprint

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Background: Prevention of violence due to severe mental disorders in psychiatric hospitals may require intrusive, restrictive and coercive therapeutic practices. Research concerning appropriate use of such interventions is limited by lack of a system for description and measurement. We set out to devise and validate a tool for clinicians and secure hospitals to assess necessity and proportionality between imminent violence and restrictive practices including de-escalation, seclusion, restraint, forced medication and others.Methods: In this retrospective observational cohort study, 28 patients on a 12 bed male admissions unit in a secure psychiatric hospital were assessed daily for six months. Data on adverse incidents were collected from case notes, incident registers and legal registers. Using the functional assessment sequence of antecedents, behaviours and consequences (A, B, C) we devised and applied a multivariate framework of structured professional assessment tools, common adverse incidents and preventive clinical interventions to develop a tool to analyse clinical practice. We validated by testing assumptions regarding the use of restrictive and intrusive practices in the prevention of violence in hospital. We aimed to provide a system for measuring contextual and individual factors contributing to adverse events and to assess whether the measured seriousness of threating and violent behaviours is proportionate to the degree of restrictive interventions used. General Estimating Equations tested preliminary models of contexts, decisions and pathways to interventions. Results: A system for measuring adverse behaviours and restrictive, intrusive interventions for prevention had good internal consistency. Interventions were proportionate to seriousness of harmful behaviours. A ‘Pareto’ group of patients (5/28) were responsible for the majority (80%) of adverse events, outcomes and interventions. The seriousness of the precipitating events correlated with the degree of restrictions utilised to safely manage or treat such behaviours.Conclusion: Observational scales can be used for restrictive, intrusive or coercive practices in psychiatry even though these involve interrelated complex sequences of interactions. The DRILL tool has been validated to assess the necessity and demonstrate proportionality of restrictive practices. This tool will be of benefit to services when reviewing practices internally, for mandatory external reviewing bodies and for future clinical research paradigms.

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Section: Rationalementioning

confidence: 99%

“…The interventions used to prevent violence are notoriously lacking in the sort of scienti c evidence required to meet the standards of Cochrane reviews or meta-analysis (3,4,5). Interventions such as seclusion and restraint are commonly condemned from the point of view of principled human rights.…”

Section: Generalisabilitymentioning

confidence: 99%

A tool to evaluate proportionality and necessity in the use of restrictive practices in forensic mental health settings: The DRILL tool (Dundrum Restriction, Intrusion and Liberty Ladders).

Kennedy

Mullaney

McKenna

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…A recent review (13) emphasizes the value of clozapine in the treatment of violent and aggressive behaviors also in a forensic population. Another recent study (14) identified two previously published systematic reviews, which in part addressed the effects of pharmacological interventions within forensic psychiatry (15,16), showing that only a few primary studies had been published, all of which were assessed as being at high risk of bias. However, the reports had methodological limitations and could potentially have resulted in relevant records having been overlooked.…”

Section: Introduction Rationalementioning

confidence: 99%

Pharmacological Treatment in Forensic Psychiatry—A Systematic Review

et al. 2020

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Background: Pharmacological treatment is of great importance in forensic psychiatry, and the vast majority of patients are treated with antipsychotic agents. There are several systematic differences between general and forensic psychiatric patients, e.g. severe violent behavior, the amount of comorbidity, such as personality disorders and/or substance abuse. Based on that, it is reasonable to suspect that effects of pharmacological treatments also may differ. The objective of this systematic review was to investigate the effects of pharmacological interventions for patients within forensic psychiatry. Methods: The systematic review protocol was pre-registered in PROSPERO (CRD42017075308). Six databases were used for literature search on January 11, 2018. Controlled trials from forensic psychiatric care reporting on the effects of antipsychotic agents, mood stabilizers, benzodiazepines, antidepressants, as well as pharmacological agents used for the treatment of addiction or ADHD, were included. Two authors independently reviewed the studies, evaluated risk of bias and assessed certainty of evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results: The literature search resulted in 1783 records (titles and abstracts) out of which 10 studies were included. Most of the studies included were retrospective and nonrandomized. Five of them focused on treatment with clozapine and the remaining five on other antipsychotics or mood stabilizers. Five studies with a high risk of bias indicated positive effects of clozapine on time from treatment start to discharge, crime-free time, time from discharge to readmission, improved clinical functioning, and reduction in aggressive behavior. Psychotic symptoms after treatment were more pronounced in

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“…Despite these common denominators, forensic patients are a heterogeneous group in terms of the details of their offense history, psychopathology and risk factors (3). That notwithstanding, in most jurisdictions, forensic psychiatric patients suffer primarily from disorders with psychotic symptomatology, but comorbidities are very common, especially personality disorders, neurodevelopmental disorders and substance-related disorders (4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

Offense-Related Issues in Forensic Psychiatric Treatment: A Thematic Analysis

2020

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Characteristics unique to forensic psychiatric treatment include coming to terms with the offenses committed, the long duration of treatment and the assessment of the risk of repeat offending. This study describes the views of both patients and staff on the significance of the patient's offense as a part of forensic psychiatric rehabilitation. Eight forensic psychiatric patients and eight forensic psychiatric nurses from two forensic psychiatric hospitals in Finland participated in this study. Data were gathered by means of thematic interview and analyzed by means of thematic analysis. The findings suggest that patients and professionals alike concur that ascertaining the factors with a bearing on the offense, and working through the offense and the factors leading up to it, constitute an essential aspect of forensic treatment. This, in turn, has a bearing on the planning and administration of a treatment plan consisting of both medical and psychosocial support and interventions intended to enable patients to live independent, fulfilling lives, thus reducing the likelihood of reoffending. The findings of this study can be used as part of the development of international, standardized treatment models for clinical forensic psychiatric practices.

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Mapping Systematic Reviews on Forensic Psychiatric Care: A Systematic Review Identifying Knowledge Gaps

Cited by 43 publications

References 16 publications

A tool to evaluate proportionality and necessity in the use of restrictive practices in forensic mental health settings: The DRILL tool (Dundrum Restriction, Intrusion and Liberty Ladders).

A tool to evaluate proportionality and necessity in the use of restrictive practices in forensic mental health settings: The DRILL tool (Dundrum Restriction, Intrusion and Liberty Ladders).

Pharmacological Treatment in Forensic Psychiatry—A Systematic Review

Offense-Related Issues in Forensic Psychiatric Treatment: A Thematic Analysis

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