Reisegger Andreas, Slamanig Rudolf, Winkler Hildegard, de Girolamo Giovanni, Carrà Giuseppe, Crocamo Cristina, Gosek Pawel, Heitzman Janusz, Salize Hans Joachim, Picchioni Marco, Wancata Johannes
Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria.
Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
CNS Spectr. 2021 Feb 5:1-11. doi: 10.1017/S1092852921000134.
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.
目的是系统研究哪些药理学策略能有效降低法医环境中精神分裂症谱系障碍（SSD）患者的暴力风险。
为进行这项系统评价，检索了六个电子数据库。两名研究人员独立筛选了6003篇摘要，得到143篇潜在论文。然后由两名独立研究人员对这些论文进行详细分析。其中，133篇因各种原因被排除，本综述纳入10篇文章。
纳入的10篇文章中，5篇仅为观察性研究，3篇为无对照的前后对照研究。1项研究采用匹配病例对照设计，1项为非随机对照试验。氯氮平研究得最为频繁，其次是奥氮平和利培酮。通常，结局指标是特定于研究的，样本量较小。经常缺少相关的方法学信息。由于研究设计和结局的异质性，无法应用荟萃分析方法。
由于存在重大的方法学局限性，很难就降低法医精神病学环境中SSD患者暴力风险的最有效药理学策略得出任何确凿结论。迫切需要在病例定义、结局指标、样本量和研究设计方面采用更严格方法的研究。
