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Systematic Review ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Psychiatry | doi: 10.3389/fpsyt.2018.00452

Mapping Systematic Reviews on Forensic Psychiatric Care: Identifying Knowledge Gaps

  • 1Department of Clinical Neuroscience, Karolinska Institutet (KI), Sweden
  • 2Department of Forensic Psychiatry, Swedish National Board of Forensic Medicine, Sweden
  • 3Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Sweden
  • 4Forensic Psychiatric Clinic, Sahlgrenska University Hospital, Sweden
  • 5Department of Forensic Psychiatry, Swedish National Board of Forensic Medicine, Sweden
  • 6Statens Beredning för Medicinsk Utvärdering, Sweden
  • 7Department of Neuroscience, Psychiatry, Uppsala University, Sweden
  • 8Department of Clinical Sciences, Child and Adolescent Psychiatry, Lund University, Sweden

Background
Forensic psychiatric care treats mentally disordered offenders who suffer mainly from psychotic disorders, although comorbidities such as personality disorders, neurodevelopmental disorders, and substance abuse are common. A large proportion of these patients have committed violent crimes. Their care is involuntary, and their caregivers’ mission is complex: not only to rehabilitate the patient, but also to consider their risk for reoffending and their risk to society. The objective of this overview of systematic reviews is to identify, appraise, and summarize the existing knowledge in forensic psychiatric care and identify gaps in that knowledge that require further research.
Methods
We undertook a systematic literature search for systematic reviews in five defined domains considered important daily clinical practice in the forensic psychiatric care: (1) diagnostic assessment and risk assessments; (2) pharmacological treatment; (3) psychological interventions; (4) psychosocial interventions, rehabilitation, and habilitation; and (5) restraint interventions. The target population was mentally disordered offenders (forensic psychiatric patients aged >15 years). Each abstract and full text review was assessed by two of the authors. Relevant reviews then were assessed for bias, and those with moderate or low risk of bias were included.
Results
Of 38 systematic reviews meeting the inclusion criteria, only four had a moderate risk of bias. Two aimed to incorporate as many aspects of forensic psychiatric care as possible, one investigated non-pharmacological interventions to reduce aggression in forensic psychiatric care, and one focused on women with intellectual disabilities in forensic care. However, most of the primary studies included in the reviews had high risks of bias, and therefore, no conclusions could be drawn. All of our identified domains must be considered knowledge gaps.
Conclusion
We could not answer any of our research questions within the five domains because of the high risk of bias in the primary studies in the identified systematic reviews. There is an urgent need for more research on forensic psychiatric care since all of our studied domains were considered knowledge gaps.

Keywords: Forensic psychiatric care, Mentally disorder offenders, risk assesment, pharmacological treatment, phycological interventions, Psychosocial intervention, restraint interventions, Systematic reviews

Received: 19 Jun 2018; Accepted: 31 Aug 2018.

Edited by:

Athanassios Douzenis, National and Kapodistrian University of Athens Medical School, Greece

Reviewed by:

Georgios A. Tzeferakos, National and Kapodistrian University of Athens, Greece
Stelios P. Kympouropoulos, University General Hospital Attikon, Greece  

Copyright: © 2018 Howner, Andine, Bertilsson, Hultcrantz, Lindström, Mowafi, Snellman and Hofvander. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: MD, PhD. Katarina Howner, Karolinska Institutet (KI), Department of Clinical Neuroscience, Solna, Sweden, katarina.howner@ki.se