Wolf Achim, Whiting Daniel, Fazel Seena
Department of Psychiatry, University of Oxford, UK.
J Forens Psychiatry Psychol. 2017;28(5):659-673. doi: 10.1080/14789949.2017.1284886. Epub 2017 Jan 31.
Relative risks of violence in psychiatric patients are high compared to the general population and existing evidence in non-psychiatric populations may not translate to reductions in violence in psychiatric populations. We searched 10 databases including Medline, EMBASE, CINAHL and Scopus, from inception until August 2015 for systematic reviews and meta-analyses of violence prevention interventions in psychiatry. Reviews were included if they used a hard outcome measure (i.e. police or hospital recorded violence, or reincarceration) and contained randomized or non-randomized controlled studies. Five reviews met our inclusion criteria ( = 8876 patients in total), of which four received a GRADE rating of 'low' or 'very low'. Three randomized studies ( = 636) reported that therapeutic community interventions may reduce reincarceration in drug-using offenders with co-occurring mental illness ('moderate' GRADE rating). The lack of intervention research in violence prevention in general and forensic psychiatry suggests that interventions from non-psychiatric populations may need to be relied upon.
与普通人群相比，精神病患者的暴力相对风险较高，非精神病患者群体的现有证据可能无法转化为精神病患者群体暴力行为的减少。我们检索了10个数据库，包括Medline、EMBASE、CINAHL和Scopus，从建库至2015年8月，查找关于精神病学中暴力预防干预措施的系统评价和荟萃分析。如果综述使用了硬性结局指标（即警方或医院记录的暴力行为，或再次入狱）且包含随机或非随机对照研究，则纳入该综述。五项综述符合我们的纳入标准（总共8876名患者），其中四项的GRADE评分为“低”或“极低”。三项随机研究（共636名患者）报告称，治疗性社区干预可能会减少同时患有精神疾病的吸毒罪犯的再次入狱率（GRADE评分为“中等”）。总体而言，普通精神病学和法医精神病学中暴力预防干预研究的缺乏表明，可能需要依赖非精神病患者群体的干预措施。
