Reviews in Forensic Psychiatry will publish high-quality scholarly review papers on key topics in Forensic Psychiatry. It aims to highlight recent advances in the field, whilst emphasizing important directions and new possibilities for future inquiries. We anticipate the research presented will promote discussion in the Forensic Psychiatry community that will translate to best practice applications in clinical, public health and policy settings. The Reviews in Forensic Psychiatry collection welcomes full-length, mini, or systematic review papers. New articles will be added to this collection as they are published.

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Frontiers in Psychiatry

Forensic Psychiatry

Reviews in Psychiatry 2022: Forensic Psychiatry

I am pleased to introduce this edition&#x2019;s Research Topic review in forensic psychiatry. The breadth and depth of the submissions in this review speak to the robust nature of research in forensic psychiatry. The subjects of the articles are wide ranging, speaking to the innovative questions being asked in the field.<a href="https://doi.org/10.3389/fpsyt.2023.1217561">Tomlin et&nbsp;al.</a> tackle a controversial topic that is trending internationally. Forensic psychiatry has historically tried to find an ethical home between the competing principles of beneficence and autonomy, especially given the coercive underpinnings of most, even most enlightened, forensic psychiatry systems.The rampant substance abuse epidemic and its impermeability to treatment as usual, continues to shock and dismay many in high middle- and low-income countries. It is not surprising then that there is an increased interest, including political interest, in mandatory substance use treatment for justice involved persons. This paper on mandatory substance use treatment in Germany provides some insight into the impact of this treatment on recidivism in this population. Key is their recommendation for further research with a focus on recovery and strength-based interventions. This paper provides guidance for much needed research-as our countries tackle substance use disorders. Mandatory substance use treatment clearly comes in many forms which provide opportunities to find a balance between choice and mandatory treatment, with recidivism only one of the outcomes we should measure.Aggression sits as a key behaviour that is measured, predicted, managed and sometimes mitigated in forensic psychiatry practice. Being over-determined aggressive behaviours are difficult to understand and manage. Risk management strategies have utilized a variety of medications to treat the underlying illness or disorder contributing to aggression, or even simply targeting symptoms. Apart from treating the symptoms of schizophrenia and bipolar disorder, the use of medications to treat aggression generally has been variably successful and can be associated with significant troubling side effects. Chemical restraint can at times linger and evolve into “chemical restraining treatment”, raising significant ethical concerns. <a href="https://doi.org/10.3389/fpsyt.2023.1176061">Choy</a> looks at alternative strategies to reduce aggression, specifically the impact of the Omega 3 fatty acids, vitamin D, magnesium and zinc. Omega 3 levels have long been studied in many medical and nutritional domains, but the results give us a useful focus for future research. This review provides us with fresh non-pharmacological ideas as we continue to search for and understand manage aggression.In in many countries art therapies have been phased out as treatment options in forensic psychiatry institutions or hospital, for a variety of reasons including financial and a paucity of research. The study by <a href="https://doi.org/10.3389/fpsyt.2023.1128252">Abbing et&nbsp;al.</a> addresses the limited research on the topic of art therapy, drama therapy and dance therapy. Their systemic review, thematic analysis and meta-analysis provides us with useful information. For example, the effect on risk and protective factors appears significant. They caution us as the analysis is explorative but again is a call then for more work on the effectiveness and mechanisms of change for arts therapies in forensic psychiatry. This is particularly welcome as sadly many programs in forensic psychiatry can take the form of a controlled hotel with medication administration as the main intervention.Terrorism and violent extremism have been common topics of discussion, review, study and speculation as of late. This is an area which is complex and difficult to understand. Apart from broad conclusions, and sometimes politically slanted, we know very little about the psychopathology, if there is psychopathology at all, of perpetrators of terror or violent extremism. Most of the studies have only looked at men. <a href="https://doi.org/10.3389/fpsyt.2023.1123243">Rakhshandehroo et&nbsp;al.</a> in the systematic review tackle the topic of female perpetrators of terrorism and violent extremism. Terrorism and violent extremism are not purely a male domain and in fact women are in increasing percentage of perpetrators. Curiously many studies assume an element of psychopathology when somebody commits a terrorist or extremist motivated act. They are however silent on the purely politically motivated violent acts, and where these derive from. Clearly personality disorders feature in some studies but to the surprise of the authors there is little known about the psychopathology of the female terror and violent extremism perpetrators. Although prediction management and risk of terrorism and violence extremism is the business of many agencies, disciplines and professions, forensic psychiatrists are often called on to provide expert opinions. This controversial area begs for more research.It is a pleasure to see the range of forensic psychiatry expertise as demonstrated by the articles in our review. Forensic psychiatry is a rapidly developing specialty and has moved beyond the medicolegal to other challenging areas. The authors in this review cover a wide range of topics and talk to the opportunities for more exploration and research as we try to improve our understanding of the many elements that make up the field of forensic psychiatry, particularly when it comes to trying to understand aggression and violence.GC: Writing &#x2013; original draft, Writing &#x2013; review &amp; editing.The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Editorial: Reviews in psychiatry 2022: forensic psychiatry

Many jurisdictions implement mandatory substance use treatment for justice-involved persons. Germany is one such country; however, debates about the appropriateness and effectiveness of this disposal abound. Very little attention has been paid in the international literature to patients receiving mandatory treatment in Germany. This systematic review synthesises research on patients receiving substance use treatment in forensic hospitals under §64 of the German Penal Code with regard to three primary outcomes: treatment completion, reoffending, and the recurrence of substance use. Forty-five publications reporting on 36 studies were reviewed; publication dates ranged from 1988 to 2023. On average, 47% of patients did not successfully complete treatment, compared to 45% who did. Average follow-up reconviction rates were higher than in mentally ill and general offender populations as reported elsewhere. Approximately half of all patients reused substances during treatment. Suggestions for future research, including a focus on strength- and recovery-based indicators, and harmonising routine outcomes measurements, are given.

Many jurisdictions implement mandatory substance use treatment for justice-involved persons. Germany is one such country; however, debates about the appropriateness and effectiveness of this disposal abound. Very little attention has been paid in the international literature to patients receiving mandatory treatment in Germany. This systematic review synthesises research on patients receiving substance use treatment in forensic hospitals under &#xa7;64 of the German Penal Code with regard to three primary outcomes: treatment completion, reoffending, and the recurrence of substance use. Forty-five publications reporting on 36 studies were reviewed; publication dates ranged from 1988 to 2023. On average, 47% of patients did not successfully complete treatment, compared to 45% who did. Average follow-up reconviction rates were higher than in mentally ill and general offender populations as reported elsewhere. Approximately half of all patients reused substances during treatment. Suggestions for future research, including a focus on strength- and recovery-based indicators, and harmonising routine outcomes measurements, are given.

Mandatory substance use treatment for justice-involved persons in Germany: a systematic review of reoffending, treatment and the recurrence of substance use outcomes

IntroductionTerrorism and violent extremism are major social threats worldwide and are committed not only by men but also by women. Previous research has shown indications of psychopathology, among other personal and contextual factors, as a potential risk factor for perpetrating terrorist and violent extremist crimes. Despite the fact that women have engaged in acts of terrorism and violent extremism throughout history, the vast majority of literature on psychopathology so far has been mainly focused on men with terrorist and violent extremist behavior. As women's engagement in terrorism and violent extremism is increasing, and gender differences in psychopathology in offenders of terrorism or violent extremism may exist based on empirical evidence for such differences in offenders of violence, gender-informed research into psychopathology as a potential risk factor for offending is of pivotal importance for improving the effectiveness of counter-terrorism interventions. The present systematic review was designed to examine what empirical knowledge exists on the presence and potential contributing role of psychopathology in female perpetrators of terrorism or violent extremism.</sec>MethodsA literature search was conducted to identify primary source studies in PsycINFO, PubMed, Embase, Web of Science, and Sociological Abstracts. ASReview as an artificial intelligence software was used to screen references.</sec>ResultsIn total, eight studies were included, of which only two studies distinguished prevalence rates and types of psychopathology separately for women, indicating personality disorder as most common. All four out of the eight studies that reported on the relationship between psychopathology and terrorism and violent extremism assumed psychopathology to be a contributing factor in engaging in terrorist or violent extremist acts. However, none of these four studies reported on potentially present female-specific mechanisms of the role of psychopathology in offenses.</sec>DiscussionThe present systematic review draws the striking conclusion that there is a lack of clearly described empirical studies on psychopathology in female perpetrators of terrorism and violent extremism and emphasizes the importance of more future empirically based inquiries on this topic by the forensic psychiatric field.</sec>Systematic review registration<ext-link ext-link-type="uri" xlink:href="https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=275354" xmlns:xlink="http://www.w3.org/1999/xlink">https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=275354</ext-link>, identifier: CRD42021275354.</sec>

Introduction: Terrorism and violent extremism are major social threats worldwide and are committed not only by men but also by women. Previous research has shown indications of psychopathology, among other personal and contextual factors, as a potential risk factor for perpetrating terrorist and violent extremist crimes. Despite the fact that women have engaged in acts of terrorism and violent extremism throughout history, the vast majority of literature on psychopathology so far has been mainly focused on men with terrorist and violent extremist behavior. As women's engagement in terrorism and violent extremism is increasing, and gender differences in psychopathology in offenders of terrorism or violent extremism may exist based on empirical evidence for such differences in offenders of violence, gender-informed research into psychopathology as a potential risk factor for offending is of pivotal importance for improving the effectiveness of counter-terrorism interventions. The present systematic review was designed to examine what empirical knowledge exists on the presence and potential contributing role of psychopathology in female perpetrators of terrorism or violent extremism.Methods: A literature search was conducted to identify primary source studies in PsycINFO, PubMed, Embase, Web of Science, and Sociological Abstracts. ASReview as an artificial intelligence software was used to screen references.Results: In total, eight studies were included, of which only two studies distinguished prevalence rates and types of psychopathology separately for women, indicating personality disorder as most common. All four out of the eight studies that reported on the relationship between psychopathology and terrorism and violent extremism assumed psychopathology to be a contributing factor in engaging in terrorist or violent extremist acts. However, none of these four studies reported on potentially present female-specific mechanisms of the role of psychopathology in offenses.Discussion: The present systematic review draws the striking conclusion that there is a lack of clearly described empirical studies on psychopathology in female perpetrators of terrorism and violent extremism and emphasizes the importance of more future empirically based inquiries on this topic by the forensic psychiatric field.Systematic review registration: <a href="https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=275354" style="color:grey;">https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=275354</a>, identifier: CRD42021275354.

Psychopathology in female offenders of terrorism and violent extremism: a systematic review

Although the vast majority of patients in forensic psychiatry are treated using pharmacological agents, clinical and ethical concerns about their use have led to the consideration of alternative strategies to reduce aggression that is common in forensic psychiatric settings. One non-invasive and benign biologically-based treatment approach involves nutrition. This article provides a mini-review of the recent evidence on four salient nutritional factors associated with aggressive behavior, namely omega-3 fatty acids, vitamin D, magnesium, and zinc. The current evidence base indicates that lower omega-3 levels are associated with increased aggression. Although research on vitamin D and zinc in relation to aggressive behavior is more limited, there is initial evidence that they are negatively associated with aggression in healthy participants and in psychiatric samples. The relationship between magnesium and aggression varies depending on how magnesium is assessed. Findings from experimental trials reveal that nutritional intervention in the form of omega-3 supplementation has the potential to serve as an effective mode of treatment, with effects that can last beyond the intervention period. There is also support for the utility of nutrition to improve our understanding of how social processes are linked to aggression. In light of the nascent, but promising findings on the role of nutritional factors on aggressive behavior, directions for future research are discussed.

Although the vast majority of patients in forensic psychiatry are treated using pharmacological agents, clinical and ethical concerns about their use have led to the consideration of alternative strategies to reduce aggression that is common in forensic psychiatric settings. One non-invasive and benign biologically-based treatment approach involves nutrition. This article provides a mini-review of the recent evidence on four salient nutritional factors associated with aggressive behavior, namely omega-3 fatty acids, vitamin D, magnesium, and zinc. The current evidence base indicates that lower omega-3 levels are associated with increased aggression. Although research on vitamin D and zinc in relation to aggressive behavior is more limited, there is initial evidence that they are negatively associated with aggression in healthy participants and in psychiatric samples. The relationship between magnesium and aggression varies depending on how magnesium is assessed. Findings from experimental trials reveal that nutritional intervention in the form of omega-3 supplementation has the potential to serve as an effective mode of treatment, with effects that can last beyond the intervention period. There is also support for the utility of nutrition to improve our understanding of how social processes are linked to aggression. In light of the nascent, but promising findings on the role of nutritional factors on aggressive behavior, directions for future research are discussed.

Nutritional factors associated with aggression

IntroductionMental health care provided to offenders with psychiatric problems in forensic settings mainly consists of verbal oriented treatments. In addition, experience-based therapies are used such as (creative) arts therapies: (visual) art therapy, music therapy, drama therapy and dance (movement) therapy. There are indications for effectiveness of arts therapies, but a systematic overview of effect studies of all arts therapies in forensic care is lacking.</sec>MethodsFirst, we performed a systematic review. Second, Thematic Analysis was used to synthesize the qualitative narrative results and define the hypothesized mechanisms of change. Third, we performed a meta-analysis to investigate the effects of arts therapies in reducing psychosocial problems of offenders. Twenty-three studies were included in the review. Quality and risk of bias was assessed using EPHPP (Effective Public Health Practice Project).</sec>ResultsThe included studies were heterogeneous in type of outcome measures and intervention characteristics. Synthesis of mechanisms of change involved in the methodical use of the arts in arts therapies resulted in a description of regulatory processes which are stimulated in arts therapies: perceptive awareness (interoceptive and exteroceptive), the regulation of emotions, stress, impulses, cognitions, social regulation, and self-expression. These processes play a role in developing prevention, coping and self-management skills. Eighteen studies were included in the meta-analyses (11 RCTs/CCTs; 7 pre-post studies). The meta-analyses indicated significant effects on both risk factors (psychiatric symptoms and addiction) and protective factors for criminal behavior (social functioning and psychological functioning). Effects on criminal and/or antisocial behavior were not significant, but this outcome measure was scarcely used among the studies.</sec>DiscussionThe analyses in this study should be considered explorative. More research is needed to gain more solid conclusions about effectiveness and mechanisms of change of arts therapies in forensic institutions. However, the results of this first systematic review, synthesis of mechanisms and meta-analysis in this field are promising and show effects of arts therapies on risk and protective factors in individuals in forensic institutions.</sec>Systematic review registration<ext-link ext-link-type="uri" xlink:href="https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020217884" xmlns:xlink="http://www.w3.org/1999/xlink">https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020217884</ext-link>, identifier: CRD42020217884.</sec>

Introduction: Mental health care provided to offenders with psychiatric problems in forensic settings mainly consists of verbal oriented treatments. In addition, experience-based therapies are used such as (creative) arts therapies: (visual) art therapy, music therapy, drama therapy and dance (movement) therapy. There are indications for effectiveness of arts therapies, but a systematic overview of effect studies of all arts therapies in forensic care is lacking.Methods: First, we performed a systematic review. Second, Thematic Analysis was used to synthesize the qualitative narrative results and define the hypothesized mechanisms of change. Third, we performed a meta-analysis to investigate the effects of arts therapies in reducing psychosocial problems of offenders. Twenty-three studies were included in the review. Quality and risk of bias was assessed using EPHPP (Effective Public Health Practice Project).Results: The included studies were heterogeneous in type of outcome measures and intervention characteristics. Synthesis of mechanisms of change involved in the methodical use of the arts in arts therapies resulted in a description of regulatory processes which are stimulated in arts therapies: perceptive awareness (interoceptive and exteroceptive), the regulation of emotions, stress, impulses, cognitions, social regulation, and self-expression. These processes play a role in developing prevention, coping and self-management skills. Eighteen studies were included in the meta-analyses (11 RCTs/CCTs; 7 pre-post studies). The meta-analyses indicated significant effects on both risk factors (psychiatric symptoms and addiction) and protective factors for criminal behavior (social functioning and psychological functioning). Effects on criminal and/or antisocial behavior were not significant, but this outcome measure was scarcely used among the studies.Discussion: The analyses in this study should be considered explorative. More research is needed to gain more solid conclusions about effectiveness and mechanisms of change of arts therapies in forensic institutions. However, the results of this first systematic review, synthesis of mechanisms and meta-analysis in this field are promising and show effects of arts therapies on risk and protective factors in individuals in forensic institutions.Systematic review registration: <a href="https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020217884" style="color:grey;">https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020217884</a>, identifier: CRD42020217884.