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California State Hospital Violence Assessment and Treatment (Cal-VAT) guidelines

  • Stephen M. Stahl (a1) (a2) (a3) (a4), Debbi A. Morrissette (a3) (a5) (a6), Michael Cummings (a4) (a7), Allen Azizian (a4) (a8) (a9), Shannon Bader (a4) (a7), Charles Broderick (a4) (a10), Laura Dardashti (a4) (a11), Darci Delgado (a4) (a12), Jonathan Meyer (a1) (a4) (a7), Jennifer O’Day (a4) (a11), George Proctor (a4) (a7), Benjamin Rose (a4) (a13), Marie Schur (a4) (a10), Eric Schwartz (a4) (a12), Susan Velasquez (a4) (a7) and Katherine Warburton (a4) (a14)...

Here we provide comprehensive guidelines for the assessment and treatment of violence and aggression of various etiologies, including psychotic aggression and impulsive aggression due to schizophrenia, mood disorders, ADHD, or trauma, and predatory aggression due to psychopathy and other personality disorders. These guidelines have been developed from a collection of prescribing recommendations, clinical trial results, and years of clinical experience in treating patients who are persistently violent or aggressive in the California Department of State Hospital System. Many of the recommendations provided in these guidelines employ off-label prescribing practices; thus, sound clinical judgment based on individual patient needs and according to institution formularies must be considered when applying these guidelines in clinical practice.

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1. Diaz-Marsa, M, Gonzalez Bardanca, S, Tajima, K, Garcia-Albea, J, Navas, M, Carrasco, JL. Psychopharmacological treatment in borderline personality disorder. Actas Esp Psiquiatr. 2008; 36(1): 3949.
2. Buscema, CA, Abbasi, QA, Barry, DJ, Lauve, TH. An algorithm for the treatment of schizophrenia in the correctional setting: the Forensic Algorithm Project. J Clin Psychiatry. 2000; 61(10): 767783.
3. Castle, D, Daniel, J, Knott, J, Fielding, J, Goh, J, Singh, B. Development of clinical guidelines for the pharmacological management of behavioural disturbance and aggression in people with psychosis. Australas Psychiatry. 2005; 13(3): 247252.
4. Herrmann, N, Lanctôt, KL, Hogan, DB. Pharmacological recommendations for the symptomatic treatment of dementia: the Canadian Consensus Conference on the Diagnosis and Treatment of Dementia 2012. Alzheimers Res Ther. 2013; 5(Suppl 1): S5.
5. List, BA, Barzman, DH. Evidence-based recommendations for the treatment of aggression in pediatric patients with attention deficit hyperactivity disorder. Psychiatr Q. 2011; 82(1): 3342.
6. Morana, HC, Camara, FP. International guidelines for the management of personality disorders. Curr Opin Psychiatry. 2006; 19(5): 539543.
7. Oliver-Africano, P, Murphy, D, Tyrer, P. Aggressive behaviour in adults with intellectual disability: defining the role of drug treatment. CNS Drugs. 2009; 23(11): 903913.
8. Taft, CT, Creech, SK, Kachadourian, L. Assessment and treatment of posttraumatic anger and aggression: a review. J Rehabil Res Dev. 2012; 49(5): 777788.
9. Tyrer, P, Seivewright, N. Pharmacological treatment of personality disorders. Clin Neuropharmacol. 1988; 11(6): 493499.
10. Vickland, V, Chilko, N, Draper, B, Low, LF, O’Connor, D, Brodaty, H. Individualized guidelines for the management of aggression in dementia—Part 2: appraisal of current guidelines. Int Psychogeriatr. 2012; 24(7): 11251132.
11. Vickland, V, Chilko, N, Draper, B, Low, LF, O’Connor, D, Brodaty, H. Individualized guidelines for the management of aggression in dementia—Part 1: key concepts. Int Psychogeriatr. 2012; 24(7): 11121124.
12. Warden, DL, Gordon, B, McAllister, TW, et al. Guidelines for the pharmacologic treatment of neurobehavioral sequelae of traumatic brain injury. J Neurotrauma. 2006; 23(10): 14681501.
13. Allen, MH. Currier GW, Hughes DH, Docherty JP, Carpenter D, Ross R. Treatment of behavioral emergencies: a summary of the expert consensus guidelines. J Psychiatr Pract. 2003; 9(1): 1638.
14. Fava, M. Psychopharmacologic treatment of pathologic aggression. Psychiatr Clin North Am. 1997; 20(2): 427451.
15. Sheard, MH. Clinical pharmacology of aggressive behavior. Clin Neuropharmacol. 1988; 11(6): 483492.
16. Tardiff, K. The current state of psychiatry in the treatment of violent patients. Arch Gen Psychiatry. 1992; 49(6): 493499.
17. Wong, SC, Gordon, A, Gu, D. Assessment and treatment of violence-prone forensic clients: an integrated approach. Br J Psychiatry Suppl. 2007; 49: s66s74.
18. Dack, C, Ross, J, Papadopoulos, C, Stewart, D, Bowers, L. A review and meta-analysis of the patient factors associated with psychiatric in-patient aggression. Acta Psychiatr Scand. 2013; 127(4): 255268.
19. Howland, RH. Limitations of evidence in the practice of evidence-based medicine. J Psychosoc Nurs Ment Health Serv. 2007; 45(11): 1316.
20. Kennedy, HG. Therapeutic uses of security: mapping forensic mental health services by stratifying risk. Advances in Psychiatric Treatment. 2002; 8(6): 433443.
21. Vaaler, AE, Iversen, VC, Morken, G, Flovig, JC, Palmstierna, T, Linaker, OM. Short-term prediction of threatening and violent behaviour in an acute psychiatric intensive care unit based on patient and environment characteristics. BMC Psychiatry. 2011; 11: 44.
22. Bandura, A. Psychological mechanisms of aggression. In: Geen RG, Donnerstein EI, eds. Aggression: Theoretical and Empirical Reviews—Vol 1, Theoretical and Methodological Issues. New York: Academic Press; 1983: 140.
23. Berkowitz, L. Aggression: Its Causes, Consequences, and Control. New York: McGraw-Hill Higher Education; 1993.
24. Hemphill, JF, Hare, RD, Wong, S. Psychopathy and recidivism: a review. Legal and Criminological Psychology. 1998; 3(1): 139170.
25. Volavka, J, Citrome, L. Pathways to aggression in schizophrenia affect results of treatment. Schizophr Bull. 2011; 37(5): 921929.
26. Hare, RD, Neumann, CS. Psychopathy as a clinical and empirical construct. Annu Rev Clin Psychol. 2008; 4: 217246.
27. Hankin, CS, Bronstone, A, Koran, LM. Agitation in the inpatient psychiatric setting: a review of clinical presentation, burden, and treatment. J Psychiatr Pract. 2011; 17(3): 170185.
28. Joshi, A, Krishnamurthy, VB, Purichia, H, Hollar-Wilt, L, Bixler, E, Rapp, M. “What’s in a name?” Delirium by any other name would be as deadly: a review of the nature of delirium consultations. J Psychiatr Pract. 2012; 18(6): 413418.
29. Wortley, R. Situational Prison Control: Crime Prevention in Correctional Institutions. Cambridge, UK: Cambridge University Press; 2002.
30. Gadon, L, Johnstone, L, Cooke, D. Situational variables and institutional violence: a systematic review of the literature. Clin Psychol Rev. 2006; 26(5): 515534.
31. Baldwin, S. Effects of furniture rearrangement on the atmosphere of wards in a maximum-security hospital. Hosp Community Psychiatry. 1985; 36(5): 525528.
32. Zaslove, MO, Beal, M, McKinney, RE. Changes in behaviors of inpatients after a ban on the sale of caffeinated drinks. Hosp Community Psychiatry. 1991; 42(1): 8485.
33. Ekland-Olson, S, Barrick, DM, Cohen, LE. Prison overcrowding and disciplinary problems: an analysis of the Texas prison system. Journal of Applied Behavioral Science. 1983; 19(2): 163192.
34. Mabli, J, Holley, C, Patrick, J, Walls, J. Age and prison violence: increasing age heterogeneity as a violence-reducing strategy in prisons. Criminal Justice and Behavior. 1979; 6(2): 175186.
35. Cooke, DJ, Wozniak, E. PRISM applied to a critical incident review: a case study of the Glendairy prison riot and its aftermath in Barbados. International Journal of Forensic Mental Health. 2010; 9(3): 159172.
36. Ekland-Olson, S. Crowding, social control, and prison violence: evidence from the post-Ruiz years in Texas. Law & Society Review. 1986; 20(3): 389421.
37. Lester, D. Overcrowding in prisons and rates of suicide and homicide. Percept Mot Skills. 1990; 71(1): 274.
38. Palmstierna, T, Huitfeldt, B, Wistedt, B. The relationship of crowding and aggressive behavior on a psychiatric intensive care unit. Hosp Community Psychiatry. 1991; 42(12): 12371240.
39. Flannery, RB Jr, Hanson, MA, Penk, WE, Flannery, GJ. Violence and the lax milieu? Preliminary data. Psychiatr Q. 1996; 67(1): 4750.
40. Morrison, E, Morman, G, Bonner, G, Taylor, C, Abraham, I, Lathan, L. Reducing staff injuries and violence in a forensic psychiatric setting. Arch Psychiatr Nurs. 2002; 16(3): 108117.
41. Katz, P, Kirkland, FR. Violence and social structure on mental hospital wards. Psychiatry. 1990; 53(3): 262277.
42. Flannery, RB Jr. Precipitants to psychiatric patient assaults on staff: review of empirical findings, 1990–2003, and risk management implications. Psychiatr Q. 2005; 76(4): 317326.
43. Flannery, RB Jr, Hanson, MA, Penk, WE. Risk factors for psychiatric inpatient assaults on staff. Journal of Mental Health Administration. 1994; 21(1): 2431.
44. Flannery, RB, Staffieri, A, Hildum, S, Walker, AP. The violence triad and common single precipitants to psychiatric patient assaults on staff: 16-year analysis of the Assaulted Staff Action Program. Psychiatr Q. 2011; 82(2): 8593.
45. Mistral, W, Hall, A, McKee, P. Using therapeutic community principles to improve the functioning of a high care psychiatric ward in the UK. Int J Ment Health Nurs. 2002; 11(1): 1017.
46. Flannery, RB Jr, White, DL, Flannery, GJ, Walker, AP. Time of psychiatric patient assaults: fifteen-year analysis of the Assaulted Staff Action Program (ASAP). Int J Emerg Ment Health. 2007; 9(2): 8995.
47. Davies, W, Burgess, PW. Prison officers’ experience as a predictor of risk of attack: an analysis within the British prison system. Medicine, Science and the Law. 1988; 28(2): 135138.
48. Hamadeh, RR, Al Alaiwat, B, Al Ansari, A. Assaults and nonpatient-induced injuries among psychiatric nursing staff in Bahrain. Issues Ment Health Nurs. 2003; 24(4): 409417.
49. Webster, CD, Nicholls, TD, Martin, ML, Desmarais, SL, Brink, J. Short-Term Assessment of Risk and Treatability (START): the case for a new structured professional judgment scheme. Behav Sci Law. 2006; 24(6): 747766.
50. Stewart, D, Van der Merwe, M, Bowers, L, Simpson, A, Jones, J. A review of interventions to reduce mechanical restraint and seclusion among adult psychiatric inpatients. Issues Ment Health Nurs. 2010; 31(6): 413424.
51. Bowers, L, Stewart, D, Papadopoulos, C, et al. Inpatient Violence and Aggression: A Literature Review. Report from the Conflict and Containment Reduction Research Programme London: Institute of Psychiatry, King’s College London; 2011.
52. Reisig, MD. Administrative control and inmate homicide. Homicide Studies. 2002; 6(1): 84103.
53. Templeton, L, Gray, S, Topping, J. Seclusion: changes in policy and practice on an acute psychiatric unit. Journal of Mental Health. 1998; 7(2): 199202.
54. Jayewardene, CH, Doherty, P. Individual violence in Canadian penitentiaries. Canadian Journal of Criminology. 1985; 27(4): 429439.
55. Porporino, FJ, Doherty, PD, Sawatsky, T. Characteristics of homicide victims and victimizations in prisons: a Canadian historical perspective. International Journal of Offender Therapy and Comparative Criminology. 1987; 31(2): 125136.
56. Bader, S, Evans, SE, Welsh, E. Aggression among psychiatric inpatients: the relationship between time, place, victims, and severity ratings. J Am Psychiatr Nurses Assoc. 2014; 20(3): 179186.
57. Grainger, C, Whiteford, H. Assault on staff in psychiatric hospitals: a safety issue. Aust N Z J Psychiatry. 1993; 27(2): 324328.
58. Hodgkinson, PE, McIvor, L, Phillips, M. Patient assaults on staff in a psychiatric hospital: a two-year retrospective study. Medicine, Science, and the Law. 1985; 25(4): 288294.
59. Weizmann-Henelius, G. Suutala HJO. Violence in a Finnish forensic psychiatric hospital. Nord J Psychiatry. 2000; 54(4): 269273.
60. Hunter, ME, Love, CC. Total quality management and the reduction of inpatient violence and costs in a forensic psychiatric hospital. Psychiatr Serv. 1996; 47(7): 751754.
61. Harris, GT, Varney, G. A ten-year study of assaults and assaulters on a maximum security psychiatric unit. Journal of Interpersonal Violence. 1986; 1(2): 173191.
62. Heilbrun, K, Lander, T. Forensic mental heath assessment. In: Spielberger C, ed. Encyclopedia of Applied Psychology, Vol 2. New York: Elsevier Academic Press; 2004: 2942.
63. Maden, A. Treating Violence: A Guide to Risk Management in Mental Health. New York: Oxford University Press; 2007.
64. Lopez, LV, Kane, JM. Plasma levels of second-generation antipsychotics and clinical response in acute psychosis: a review of the literature. Schizophr Res. 2013; 147(2–3): 368374.
65. Douglas, KS, Hart, SD, Webster, CD, Belfrage, H. HCR-20V3: Assessing risk of violence—User guide. Burnaby, Canada: Mental Health, Law, and Policy Institute, Simon Fraser University; 2013.
66. Webster, CD, Martin, ML, Brink, J, Nicholls, TD, Desmarais, SL. Manual for the Short-Term Assessment of Risk and Treatability (START) (Version 1.1). Port Coquitlam, BC, Canada: Forensic Psychiatric Services Commission and St. Joseph’s Healthcare; 2009.
67. Bjørkly, S, Hartvig, P, Heggen, FA, Brauer, H, Moger, TA. Development of a brief screen for violence risk (V-RISK-10) in acute and general psychiatry: an introduction with emphasis on findings from a naturalistic test of interrater reliability. Eur Psychiatry. 2009; 24(6): 388394.
68. Hare, RD. Manual for the Revised Psychopathy Checklist, 2nd ed. Toronto: Multi-Health Systems; 2003.
69. Monahan, J, Steadman, HJ, Robbins, PC, et al. An actuarial model of violence risk assessment for persons with mental disorders. Psychiatr Serv. 2005; 56(7): 810815.
70. Dolan, M, Fullam, R, Logan, C, Davies, G. The Violence Risk Scale Second Edition (VRS-2) as a predictor of institutional violence in a British forensic inpatient sample. Psychiatry Res. 2008; 158(1): 5565.
71. Quinsey, VL, Harris, GT, Rice, ME, Cormier, CA. Violent Offenders: Appraising and Managing Risk. Washington, DC: American Psychological Association; 1998.
72. Wong, S, Gordon, A. The Violence Risk Scale. Saskatchewan, Canada: Research Unit, Regional Psychiatric Centre, Saskatoon; 2000.
73. Ogloff, JRP, Daffern, M. The Dynamic Appraisal of Situational Aggression: an instrument to assess risk for imminent aggression in psychiatric inpatients. Behav Sci Law. 2006; 24(6): 799813.
74. Nijman, HLI, Muris, P, Merckelbach, HLGJ, et al. The staff observation aggression scale–revised (SOAS-R). Aggressive Behavior. 1999; 25(3): 197209.
75. Marder, SR. A review of agitation in mental illness: treatment guidelines and current therapies. J Clin Psychiatry. 2006; 67(Suppl 10): 1321.
76. National Institute for Health and Clinical Excellence. Violence: The Short-Term Management of Disturbed/Violent Behaviour in In-Patient Psychiatric Settings and Emergency Departments. London: Royal College of Nursing; 2005.
77. Huf, G, Alexander, J, Allen, MH, Raveendran, NS. Haloperidol plus promethazine for psychosis-induced aggression. Cochrane Database Syst Rev. 2009; (3): CD005146.
78. Huf, G, Coutinho, ES, Adams, CE. Rapid tranquillisation in psychiatric emergency settings in Brazil: pragmatic randomised controlled trial of intramuscular haloperidol versus intramuscular haloperidol plus promethazine. BMJ. 2007; 335(7625): 869.
79. Raveendran, NS, Tharyan, P, Alexander, J, Adams, CE. Rapid tranquillisation in psychiatric emergency settings in India: pragmatic randomised controlled trial of intramuscular olanzapine versus intramuscular haloperidol plus promethazine. BMJ. 2007; 335(7625): 865.
80. Nobay, F, Simon, BC, Levitt, MA, Dresden, GM. A prospective, double-blind, randomized trial of midazolam versus haloperidol versus lorazepam in the chemical restraint of violent and severely agitated patients. Acad Emerg Med. 2004; 11(7): 744749.
81. Silver, JM, Yudofsky, SC, Slater, JA, et al. Propranolol treatment of chronically hospitalized aggressive patients. J Neuropsychiatry Clin Neurosci. 1999; 11(3): 328335.
82. Stanford, MS, Anderson, NE, Lake, SL, Baldridge, RM. Pharmacologic treatment of impulsive aggression with antiepileptic drugs. Curr Treat Options Neurol. 2009; 11(5): 383390.
83. Stanford, MS, Mathias, CW, Dougherty, DM, Lake, SL, Anderson, NE, Patton, JH. Fifty years of the Barratt Impulsiveness Scale: an update and review. Personality and Individual Differences. 2009; 47(5): 385395.
84. Azermai, M, Petrovic, M, Elseviers, MM, Bourgeois, J, Van Bortel, LM, Vander Stichele, RH. Systematic appraisal of dementia guidelines for the management of behavioural and psychological symptoms. Ageing Res Rev. 2012; 11(1): 7886.
85. Langballe, EM, Engdahl, B, Nordeng, H, Ballard, C, Aarsland, D, Selbæk, G. Short- and long-term mortality risk associated with the use of antipsychotics among 26,940 dementia outpatients: a population-based study. Am J Geriatr Psychiatry. 2014; 22(4): 321331.
86. Ballard, C, Corbett, A. Agitation and aggression in people with Alzheimer’s disease. Curr Opin Psychiatry. 2013; 26(3): 252259.
87. Ruberg, SJ, Chen, L, Stauffer, V, et al. Identification of early changes in specific symptoms that predict longer-term response to atypical antipsychotics in the treatment of patients with schizophrenia. BMC Psychiatry. 2011; 11: 23.
88. Tombaugh, TN. Trail Making Test A and B: normative data stratified by age and education. Arch Clin Neuropsychol. 2004; 19(2): 203214.
89. Erhardt, D, Epstein, JN, Conners, CK, Parker, JDA, Sitarenios, G. Self-ratings of ADHD symptoms in adults II: reliability, validity, and diagnostic sensitivity. Journal of Attention Disorders. 1999; 3(3): 153158.
90. Ketter, TA. Monotherapy versus combined treatment with second-generation antipsychotics in bipolar disorder. J Clin Psychiatry. 2008; 69(Suppl 5): 915.
91. Yatham, LN, Grossman, F, Augustyns, I, Vieta, E, Ravindran, A. Mood stabilisers plus risperidone or placebo in the treatment of acute mania: international, double-blind, randomised controlled trial. [Erratum appears in Br J Psychiatry. 2003;182:369]. Br J Psychiatry. 2003; 182(2): 141147.
92. Keck, PE Jr. The role of second-generation antipsychotic monotherapy in the rapid control of acute bipolar mania. J Clin Psychiatry.. 2005; 66(Suppl 3): 511.
93. Swann, AC, Bowden, CL, Calabrese, JR, Dilsaver, SC, Morris, DD. Differential effect of number of previous episodes of affective disorder on response to lithium or divalproex in acute mania. Am J Psychiatry. 1999; 156(8): 12641266.
94. Bauer, M, Berghofer, A, Bschor, T, et al. Supraphysiological doses of L-thyroxine in the maintenance treatment of prophylaxis-resistant affective disorders. Neuropsychopharmacology. 2002; 27(4): 620628.
95. Kupka, RW. Treatment options for rapid cycling bipolar disorder. Clinical Approaches in Bipolar Disorders. 2006; 5(1): 2229.
96. Calabrese, JR, Kimmel, SE, Woyshville, MJ, et al. Clozapine for treatment-refractory mania. Am J Psychiatry. 1996; 153(6): 759764.
97. Green, AI, Tohen, M, Patel, JK, et al. Clozapine in the treatment of refractory psychotic mania. Am J Psychiatry. 2000; 157(6): 982986.
98. Suppes, T, Ozcan, ME, Carmody, T. Response to clozapine of rapid cycling versus non-cycling patients with a history of mania. Bipolar Disord. 2004; 6(4): 329332.
99. Suppes, T, Webb, A, Paul, B, Carmody, T, Kraemer, H, Rush, AJ. Clinical outcome in a randomized 1-year trial of clozapine versus treatment as usual for patients with treatment-resistant illness and a history of mania. Am J Psychiatry. 1999; 156(8): 11641169.
100. Grunze, H, Vieta, E, Goodwin, GM, et al. The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of bipolar disorders: update 2009 on the treatment of acute mania. [Erratum appears in World J Biol Psychiatry. 2009;10(3):255. Note: Dosage error in article text]. World J Biol Psychiatry. 2009; 10(2): 85116.
101. Osterberg, L, Blaschke, T. Adherence to medication. N Engl J Med. 2005; 353(5): 487497.
102. Bauer, M, Adli, M, Bschor, T, et al. Lithium’s emerging role in the treatment of refractory major depressive episodes: augmentation of antidepressants. Neuropsychobiology. 2010; 62(1): 3642.
103. Bauer, M, Forsthoff, A, Baethge, C, et al. Lithium augmentation therapy in refractory depression—update 2002. Eur Arch Psychiatry Clin Neurosci. 2003; 253(3): 132139.
104. Crossley, NA, Bauer, M. Acceleration and augmentation of antidepressants with lithium for depressive disorders: two meta-analyses of randomized, placebo-controlled trials. J Clin Psychiatry. 2007; 68(6): 935940.
105. Joffe, RT, Singer, W, Levitt, AJ, MacDonald, C. A placebo-controlled comparison of lithium and triiodothyronine augmentation of tricyclic antidepressants in unipolar refractory depression. Arch Gen Psychiatry. 1993; 50(5): 387393.
106. Nierenberg, AA, Fava, M, Trivedi, MH, et al. A comparison of lithium and T(3) augmentation following two failed medication treatments for depression: a STAR*D report. Am J Psychiatry. 2006; 163(9): 15191530; quiz 1665.
107. Komossa, K, Depping, AM, Gaudchau, A, Kissling, W, Leucht, S. Second-generation antipsychotics for major depressive disorder and dysthymia. Cochrane Database Syst Rev. 2010: 12, CD008121.
108. Nelson, JC, Papakostas, GI. Atypical antipsychotic augmentation in major depressive disorder: a meta-analysis of placebo-controlled randomized trials. Am J Psychiatry. 2009; 166(9): 980991.
109. Lam, RW, Kennedy, SH, Grigoriadis, S, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) clinical guidelines for the management of major depressive disorder in adults. III. Pharmacotherapy. J Affect Disord. 2009; 117(Suppl 1): S26S43.
110. Kho, KH, van Vreeswijk, MF, Simpson, S, Zwinderman, AH. A meta-analysis of electroconvulsive therapy efficacy in depression. J ECT. 2003; 19(3): 139147.
111. National Collaborating Centre for Mental Health. The Treatment and Management of Depression in Adults. Updated ed. London: The British Psychological Society and The Royal College of Psychiatrists; 2010.
112. Pagnin, D, de Queiroz, V, Pini, S, Cassano, GB. Efficacy of ECT in depression: a meta-analytic review. J ECT. 2004; 20(1): 1320.
113. Spijker, J, Nolen, WA. An algorithm for the pharmacological treatment of depression. Acta Psychiatr Scand. 2010; 121(3): 180189.
114. UK ECT Review Group. Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet. 2003; 361(9360): 799808.
115. Jones, RM, Arlidge, J, Gillham, R, Reagu, S, van den Bree, M, Taylor, PJ. Efficacy of mood stabilisers in the treatment of impulsive or repetitive aggression: systematic review and meta-analysis. Br J Psychiatry. 2011; 198(2): 9398.
116. Frogley, C, Anagnostakis, K, Mitchell, S, et al. A case series of clozapine for borderline personality disorder. Ann Clin Psychiatry. 2013; 25(2): 125134.
117. Butler, T, Schofield, PW, Greenberg, D, et al. Reducing impulsivity in repeat violent offenders: an open label trial of a selective serotonin reuptake inhibitor. Aust N Z J Psychiatry. 2010; 44(12): 11371143.
118. Huband, N, Ferriter, M, Nathan, R, Jones, H. Antiepileptics for aggression and associated impulsivity. Cochrane Database Syst Rev. 2010; 17(2): CD003499.
119. Mattes, JA. Medications for aggressiveness in prison: focus on oxcarbazepine. J Am Acad Psychiatry Law. 2012; 40(2): 234238.
120. Takahashi, A, Quadros, IM, de Almeida, RM, Miczek, KA. Brain serotonin receptors and transporters: initiation vs. termination of escalated aggression. Psychopharmacology (Berl). 2011; 213(2–3): 183212.
121. Young, RC, Biggs, JT, Ziegler, VE, Meyer, DA. A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry. 1978; 133(5): 429435.
122. Hart, SD, Cox, DN, Hare, RD. The Hare Psychopathy Checklist: Screening Version. Toronto: Multi-Health Systems; 1995.
123. Hare, RD. Psychopathy: a clinical and forensic overview. Psychiatr Clin North Am. 2006; 29(3): 709724.
124. Ross, RR, Ross, RD. Programme development through research. In: Ross RR, Ross RD, eds. Thinking Straight: The Reasoning and Rehabilitation Program for Delinquency Prevention and Offender Rehabilitation. Ottawa: Air Training and Publications; 1995.
125. Brown, D, Larkin, F, Sengupta, S, et al. Clozapine: an effective treatment for seriously violent and psychopathic men with antisocial personality disorder in a UK high-security hospital. CNS Spectr. In press, DOI: 10.1017/S1092852914000157.
126. Bonta, J, Andrews, DA. Risk–need–responsivity model for offender assessment and rehabilitation 2007–06. Ottawa: Her Majesty the Queen in Right of Canada; 2007.
127. Dvoskin, JA, Skeem, JL, Novaco, RW, Douglas, KS, eds. Using Social Science to Reduce Violent Offending. New York: Oxford University Press; 2012.
128. Hanson, RK, Bourgon, G, Helmus, L, Hodgson, S. The principles of effective correctional treatment also apply to sexual offenders: a meta-analysis. Criminal Justice and Behavior. 2009; 36(9): 865891.
129. Douglas, KS, Nicholls, TD, Brink, J. Reducing the risk of violence among people with serious mental illness: a critical analysis of treatment approaches. In: Kleespies PM, ed. Behavioral Emergencies: An Evidence-Based Resource for Evaluating and Managing Risk of Suicide, Violence, and Victimization. Washington, DC: American Psychological Association; 2009: 351376.
130. Beck, NC, Menditto, AA, Baldwin, L, Angelone, E, Maddox, M. Reduced frequency of aggressive behavior in forensic patients in a social learning program. Hospital Community Psychiatry. 1991; 42(7): 750752.
131. Becker, M, Love, CC, Hunter, ME. Intractability is relative: behaviour therapy in the elimination of violence in psychotic forensic patients. Legal and Criminological Psychology. 1997; 2(1): 89101.
132. Stermac, LE. Anger control treatment for forensic patients. Journal of Interpersonal Violence. 1986; 1(4): 446457.
133. Evershed, S, Tennant, A, Boomer, D, Rees, A, Barkham, M, Watsons, A. Practice-based outcomes of dialectical behaviour therapy (DBT) targeting anger and violence, with male forensic patients: a pragmatic and non-contemporaneous comparison. Crim Behav Ment Health. 2003; 13(3): 198213.
134. Drummond, DJ, Sparr, LF, Gordon, GH. Hospital violence reduction among high-risk patients. JAMA. 1989; 261(17): 25312534.
135. Carroll, E, Tyson, K. Therapeutic management of violence in residential care for severely mentally ill clients: an application for intrapsychic humanism. Smith College Studies in Social Work. 2004; 74(3): 539561.
136. Shelton, D, Sampl, S, Kesten, KL, Zhang, W, Trestman, RL. Treatment of impulsive aggression in correctional settings. Behav Sci Law. 2009; 27(5): 787800.
137. Rizvi, SL, Linehan, MM. Dialectical behavior therapy for personality disorders. Curr Psychiatry Rep. 2001; 3(1): 6469.
138. Berzins, LG, Trestman, RL. The development and implementation of dialectical behavior therapy in forensic settings. International Journal of Forensic Mental Health. 2004; 3(1): 93103.
139. Flannery, DJ, Singer, MI, Van Dulmen, M, Kretschmar, J, Belliston, L. Exposure to violence, mental health and violent behavior. In: Flannery DJ, Vazsonyi AT, Waldman I, eds. The Cambridge Handbook of Violent Behavior. Cambridge, UK: Cambridge University Press; 2007: 306319.
140. Sullivan, CP, Elbogen, EB. PTSD symptoms and family versus stranger violence in Iraq and Afghanistan veterans. Law Hum Behav. 2014; 38(1): 19.
141. Management of Post-Traumatic Stress Working Group. VA/DoD Clinical Practice Guideline for Management of Post-Traumatic Stress. Washington, DC: Department of Defense; 2010.
142. Cauffman, E, Feldman, SS, Waterman, J, Steiner, H. Posttraumatic stress disorder among female juvenile offenders. J Am Acad Child Adolesc Psychiatry. 1998; 37(11): 12091216.
143. Steiner, H, Garcia, IG, Matthews, Z. Posttraumatic stress disorder in incarcerated juvenile delinquents. J Am Acad Child Adolesc Psychiatry. 1997; 36(3): 357365.
144. Ford, JD, Chapman, J, Connor, DF, Cruise, KR. Complex trauma and aggression in secure juvenile justice settings. Criminal Justice and Behavior. 2012; 39(6): 694724.
145. Physicians for Human Rights—Health and Justice for Youth Campaign. Unique needs of girls in the juvenile justice system., 2009. Accessed January 13, 2014.
146. Flannery, DJ, Singer, MI, Wester, KL. Violence exposure, psychological trauma, and suicide risk in a community sample of dangerously violent adolescents. J Am Acad Child Adolesc Psychiatry. 2001; 40(4): 435442.
147. Najavits, LM, Schmitz, M, Gotthardt, S, Weiss, RD. Seeking safety plus exposure therapy: an outcome study on dual diagnosis men. J Psychoactive Drugs. 2005; 37(4): 425435.
148. Zlotnick, C, Najavits, LM, Rohsenow, DJ, Johnson, DM. A cognitive-behavioral treatment for incarcerated women with substance abuse disorder and posttraumatic stress disorder: findings from a pilot study. J Subst Abuse Treat. 2003; 25(2): 99105.
149. Heinrichs, RW, Zakzanis, KK. Neurocognitive deficit in schizophrenia: a quantitative review of the evidence. Neuropsychology. 1998; 12(3): 426445.
150. Keefe, RS, Bilder, RM, Harvey, PD, et al. Baseline neurocognitive deficits in the CATIE schizophrenia trial. Neuropsychopharmacology. 2006; 31(9): 20332046.
151. Keefe, RS, Fenton, WS. How should DSM-V criteria for schizophrenia include cognitive impairment? Schizophr Bull. 2007; 33(4): 912920.
152. Harris, GT, Rice, ME, Quinsey, VL. Violent recidivism of mentally disordered offenders: the development of a statistical prediction instrument. Criminal Justice and Behavior. 1993; 20(4): 315335.
153. D’Silva, K, Duggan, C, McCarthy, L. Does treatment really make psychopaths worse? A review of the evidence. J Personal Disord. 2004; 18(2): 163177.
154. Polaschek, DLL, Daly, TE. Treatment and psychopathy in forensic settings. Aggression and Violent Behavior. 2013; 18(5): 592603.
155. Salekin, RT. Psychopathy and therapeutic pessimism: clinical lore or clinical reality? Clin Psychol Rev. 2002; 22(1): 79112.
156. McGuire, J. General offending behaviour programmes: concept, theory, and practice. In: Hollin CR, Palmer EJ, eds. Offending Behaviour Programmes: Development, Application, and Controversies. Chichester, UK: John Wiley & Sons, Ltd; 2008; 69111.
157. Ross, R, Fabiano, E. Reasoning and Rehabilitation: Manual. Ottawa: Air Training and Publications; 1985.
158. Tong, LSJ, Farrington, DP. How effective is the “Reasoning and Rehabilitation” programme in reducing reoffending? A meta-analysis of evaluations in four countries. Psychology, Crime & Law. 2006; 12(1): 324.
159. Clarke, DA. Theory Manual for Enhanced Thinking Skills—Prepared for the Joint Prison Accreditation Panel. London: Home Office; 2000.
160. Renner, F, van Goor, M, Huibers, M, Arntz, A, Butz, B, Bernstein, D. Short-term group schema cognitive-behavioral therapy for young adults with personality disorders and personality disorder features: associations with changes in symptomatic distress, schemas, schema modes and coping styles. Behav Res Ther. 2013; 51(8): 487492.
161. Bernstein, DP, Arntz, A. Vos Md. Schema focused therapy in forensic settings: theoretical model and recommendations for best clinical practice. International Journal of Forensic Mental Health. 2007; 6(2): 169183.
162. Livesley, WJ. Practical Management of Personality Disorder. New York: Guilford Press; 2003.
163. The President’s Commission on Mental Health. Report to the President from The President’s Commission on Mental Health. Vol 1. Washington, DC: U.S. Government Printing Office; 1978.
164. Coombs, T, Taylor, M, Pirkis, J. Benchmarking forensic mental health organizations. Australas Psychiatry. 2011; 19(2): 133142.
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CNS Spectrums
  • ISSN: 1092-8529
  • EISSN: 2165-6509
  • URL: /core/journals/cns-spectrums
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