Pharmacological interventions to reduce violence in patients with schizophrenia in forensic psychiatry

Abstract

Background 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. Methods 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. Results 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. Conclusion 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.

Naltrexone as a possible treatment for the violent patient in forensic and non-forensic settings

“…1 The article used the WHO definition of violence which stated "A violent act is an aggressive, domineering, forceful, or assaultive verbal or physical action, most often directed against self or others." 1 The article also claimed that there are links between a range of mental disorders and violence as evidenced by a systematic review and meta-analysis on 20 original studies that illustrated a clear association between schizophrenia, substance use disorders, and violence, while risk rose markedly when substance use disorder was present. 1 Despite this supposed link, the authors also briefly acknowledged that the overall contribution of violent offenses committed by patients with schizophrenia to society's general level of violence is very small.…”

“…1 The article also claimed that there are links between a range of mental disorders and violence as evidenced by a systematic review and meta-analysis on 20 original studies that illustrated a clear association between schizophrenia, substance use disorders, and violence, while risk rose markedly when substance use disorder was present. 1 Despite this supposed link, the authors also briefly acknowledged that the overall contribution of violent offenses committed by patients with schizophrenia to society's general level of violence is very small. However, the authors did not consider that this supposed link of SSD-SUD might also be a false positive triggered by these methodological flaws.…”

“…The article in February 2021 of CNS Spectrums titled “Pharmacological interventions to reduce violence in patients with schizophrenia in forensic psychiatry” had thoroughly elucidated the lack of reliable studies that could draw firm conclusion regarding the pharmacological intervention in the reduction of violence in schizophrenia spectrum disorders (SSDs) in forensic settings due to substantial methodological limitations 1 . The article used the WHO definition of violence which stated “A violent act is an aggressive, domineering, forceful, or assaultive verbal or physical action, most often directed against self or others.” 1 The article also claimed that there are links between a range of mental disorders and violence as evidenced by a systematic review and meta-analysis of 20 original studies that illustrated a clear association between schizophrenia, substance use disorders (SUDs), and violence, while risk rose markedly when SUD was present 1 . Despite this supposed link, the authors also briefly acknowledged that the overall contribution of violent offenses committed by patients with schizophrenia to society’s general level of violence is very small.…”

Treatment adherence in forensic patients with schizophrenia spectrum disorders discharged on long-acting injectable antipsychotics: a comparative 3-year mirror-image study

“…Management of patients with SSD in forensic psychiatry may require a more assertive approach than in the general psychiatric practice. This is primarily due to their history of violence, the increased risk of violence with poor symptom control, and the court-ordered care they are obliged to undergo, which can result in impaired therapeutic alliance and non-adherence towards treatment (Reisegger et al , 2021). Therefore, better engagement with psychopharmacological strategies is key in this patient population.…”