***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background The growing popularity of offending behavior programs has led to the interest of whether such programs are effective with mentally disordered offenders . This study aim ed to evaluate the effectiveness of the Reasoning and Rehabilitation program adapted for offenders with severe mental illness ( R&R2 MHP ) . Methods A sample of 59 adult high risk males detained in a high secure hospital completed question naires  at baseline and post treatment to assess violent attitudes , anger , coping processes and social problem-solving . An informant measure of social and psychological functioning , including disruptive behavior , was completed by staff at the same time . The data of 30 patients who participated in the group condition were compared using intention to treat analysis with 29 controls who received treatment as usual . Results 80 % of group participants completed the program . In contrast to controls , significant medium-large treatment effects were found at outcome on self-reported measures of violent attitudes , social problem-solving and coping processes . Improvements were endorsed by informant ratings of disruptive behavior , social and psychological functioning . Conclusions The R&R2MHP had a comparatively low dropout rate and was effective in a sample of high risk mentally disordered offenders requiring detention in high security . Future research should use a r and omized controlled design .Trial registration Current Controlled Trials ACTRN12613000216718 Background The effectiveness of offending behaviour programs in forensic mental health setting s is not well established . Thus this study aim ed to evaluate the Reasoning and Rehabilitation Mental Health program ( R&R2 MHP ) among a mentally disordered offender ( MDO ) population . Methods A sample of 121 adult males drawn from 10 forensic mental health sites completed question naires at baseline and post-treatment to assess violent attitudes , locus of control , social problem-solving and anger . An informant measure of social and psychological functioning , including disruptive behaviour , was completed by unit staff at the same time . At three month follow-up patients completed again the violent attitudes and locus of control question naires . The data of 67 patients who participated in the group condition were compared with 54 waiting-list controls  who  received treatment as usual . Results 78 % of group participants completed the program . In contrast to controls , significant treatment effects were found at outcome on self-reported measures of violent attitudes , rational problem-solving and anger cognitions . Improvements were endorsed by informant ratings of social and psychological functioning within the establishments . At follow-up significant treatment effects were found for both violent attitudes and locus of control . Conclusions R&R2 MHP was effective in a sample of MDOs and had a comparatively low drop-out rate . Future research should use a r and omized controlled design Background In this prospect i ve study , mentally disordered perpetrators of severe violent and /or sexual crimes were followed through official registers for 59 ( range 8 to 73 ) months . The relapse rate in criminality was assessed , compared between offenders sentenced to prison versus forensic psychiatric care , and the predictive ability of various risk factors ( criminological , clinical , and of structured assessment instruments ) was investigated . Method One hundred perpetrators were consecutively assessed between 1998 and 2001 by a clinical battery of established instruments covering DSM-IV diagnoses , psychosocial background factors , and structured assessment instruments ( HCR-20 , PCL-R , and life-time aggression ( LHA ) ) . Follow-up data was collected from official registers for : ( i ) recidivistic crimes , ( ii ) crimes during ongoing sanction . Results Twenty subjects relapsed in violent criminality during ongoing sanctions ( n = 6 ) or after discharge/parole ( n = 14 ) . Individuals in forensic psychiatric care spent significantly more time at liberty after discharge compared to those in prison , but showed significantly fewer relapses . Criminological ( age at first conviction ) , and clinical ( conduct disorder and substance abuse/dependence ) risk factors , as well as scores on structured assessment instruments , were moderately associated with violent recidivism . Logistic regression analyses showed that the predictive ability of criminological risk factors versus clinical risk factors combined with scores from assessment instruments was comparable , with each set of variables managing to correctly classify about 80 % of all individuals , but the only predictors that remained significant in multiple models were criminological ( age at first conviction , and a history of substance abuse among primary relatives ) . Conclusions Only one in five relapsed into serious criminality , with significantly more relapses among subjects sentenced to prison as compared to forensic psychiatric care . Criminological risk factors tended to be the best predictors of violent relapses , while few synergies were seen when the risk factors were combined . Overall , the predictive validity of common risk factors for violent criminality was rather weak BACKGROUND Forensic psychiatry aims to reduce recidivism and makes use of risk assessment tools to achieve this goal . Various studies have reported on the predictive qualities of these instruments , but it remains unclear whether their use is associated with actual prevention of recidivism in clinical care . AIMS To test whether an intervention combining risk assessment and shared care planning is associated with a reduction in violent and criminal behaviour . METHOD A cluster r and omised controlled trial ( Netherl and s Trial Register number NTR1042 ) was conducted in three out-patient forensic psychiatric clinics . The intervention comprised risk assessment with the Short Term Assessment of Risk and Treatability ( START ) and a shared care planning protocol formulated according to shared decision-making principles . The control group received usual care . The outcome consisted of the proportion of clients with violent or criminal incidents at follow-up . RESULTS In total 58 case managers and 632 of their clients were included . In the intervention group ( n = 310 ) , 65 % received the intervention at least once . Findings showed a general treatment effect ( 22 % of clients with an incident at baseline v. 15 % at follow-up , P<0.01 ) but no significant difference between the two treatment conditions ( odds ratio ( OR ) = 1.46 , 95 % CI 0.89 - 2.44 , P = 0.15 ) . CONCLUSIONS Although risk assessment is common practice in forensic psychiatry , our results indicate that the primary goal of preventing recidivism was not reached through risk assessment embedded in shared decision-making OBJECTIVE Despite a large evidence base indicating that cognitive skills programs can reduce reoffending in individuals without mental illness , there have been no r and omized controlled trials ( RCTs ) to determine their effectiveness in mentally disordered offenders ( MDOs ) . In the first RCT of a cognitive skills program for MDOs , we aim ed to investigate whether participation in the Reasoning and Rehabilitation ( R&R ) program reduced violence and antisocial behavior in this population . METHOD Eighty-four male in patients with a psychotic disorder and a history of violence were recruited from medium secure forensic hospitals . Participants were r and omized to receive the R&R program , consisting of 36 two-hour sessions , or treatment as usual ( TAU ) .  Incidents of violence and antisocial behavior ( verbal aggression , substance use , and leave violations ) were assessed during treatment and at 12-months posttreatment . RESULTS Relative to the TAU group , incident rates of verbal aggression and leave violations during the treatment period were significantly lower in the R&R group ; the effect on verbal aggression was maintained at 12-months posttreatment . Half of those r and omized to receive R&R did not complete treatment ; post hoc analyses were therefore conducted to compare treatment responses in program completers and noncompleters . After controlling for psychopathic traits , incidents of violence , verbal aggression , and leave violations during treatment were significantly lower in program completers , and there were significant effects of program completion on verbal aggression and substance use at 12-months posttreatment . CONCLUSIONS R&R leads to a reduction in incidents of antisocial behavior in MDO population s , with potentially greater impact on those who complete treatment Abstract Objectives : To establish whether intensive case management reduces violence in patients with psychosis in comparison with st and ard case management . Design : R and omised controlled trial with two year follow up . Setting : Four inner city community mental health services . Participants : 708 patients with established psychotic illness allocated at r and om to intervention ( 353 ) or control ( 355 ) group . Intervention : Intensive case management ( caseload 10–15 per case manager ) for two years compared with st and ard case management ( 30 - 35 per case manager ) . Main outcome measure : Physical assault over two years measured by interviews with patients and case managers and examination of case notes . Results : No significant reduction in violence was found in the intensive case management group compared with the control group ( 22.7 % v 21.9 % , P=0.86 ) . Conclusions : Intensive case management does not reduce the prevalence of violence in psychotic patients in comparison with st and ard care . What is already known on this topic Psychosis and violence are known to be associated Community psychiatric interventions aim ed at reducing the risk of violence have not been evaluated What this study adds Increasing the intensity of contact between patients and case managers does not reduce the prevalence of violent behaviour in patients with psychosis Younger age , learning difficulties , and a history of violence , drug misuse , and victimisation predict violent behaviour in psychotic BACKGROUND Little information exists on treatment effectiveness in antisocial personality disorder ( ASPD ) . We investigated the feasibility and effectiveness of carrying out a r and omized controlled trial of cognitive behaviour therapy ( CBT ) in men with ASPD who were aggressive . METHOD This was an exploratory two-centre , r and omized controlled trial in a community setting . Fifty-two adult men with a diagnosis of ASPD , with acts of aggression in the 6 months prior to the study , were r and omized to either treatment as usual ( TAU ) plus CBT , or usual treatment alone . Change over 12 months of follow-up was assessed in the occurrence of any act of aggression and also in terms of alcohol misuse , mental state , beliefs and social functioning . RESULTS The follow-up rate was 79 % . At 12 months , both groups reported a decrease in the occurrence of any acts of verbal or physical aggression . Trends in the data , in favour of CBT , were noted for problematic drinking , social functioning and beliefs about others . CONCLUSIONS CBT did not improve outcomes more than usual treatment for men with ASPD who are aggressive and living in the community in this exploratory study . However , the data suggest that a larger study is required to fully assess the effectiveness of CBT in reducing aggression , alcohol misuse and improving social functioning and view of others . It is feasible to carry out a rigorous r and omized controlled trial in this group BACKGROUND Aggression and violence are serious problems in schizophrenia . Cognitive-behavioural therapy ( CBT ) has been shown to be an effective treatment for psychosis although there have been no studies to date evaluating the impact of CBT for people with psychosis and a history of violence . AIMS To investigate the effectiveness of CBT on violence , anger , psychosis and risk outcomes with people who had a diagnosis of schizophrenia and a history of violence . METHOD This was a single-blind r and omised controlled trial of CBT v. social activity therapy ( SAT ) with a primary outcome of violence and secondary outcomes of anger , symptoms , functioning and risk . Outcomes were evaluated by masked assessors at 6 and 12 months ( trial registration : NRR NO50087441 ) . RESULTS Significant benefits were shown for CBT compared with control over the intervention and follow-up period on violence , delusions and risk management . CONCLUSIONS Cognitive-behavioural therapy targeted at psychosis and anger may be an effective treatment for reducing the occurrence of violence and further investigation of its benefits is warranted Objective : There is a need to find effective treatments for individuals with antisocial and borderline personality disorder who are known to be difficult to engage and treat . Many of these individuals share considerable overlap with symptoms of ADHD , hence this study aim ed to evaluate the Reasoning and Rehabilitation ADHD program ( R&R2 ADHD ) among patients with severe personality disorder . Method : A total of 31 males detained in a “ dangerous and severe personality disorder ” unit completed question naires at baseline and post treatment to assess social problem solving , violent attitudes , anger , ADHD symptoms , emotional control , and social functioning . A total of 16 patients participated in the group condition , and their scores were compared with 15 waiting-list controls who received treatment as usual . Results : In all , 76 % of group participants completed the program . In contrast to controls , they showed significant improvements in scores with mainly medium effect sizes . Conclusion : R&R2 ADHD was effective in a small sample of severely personality-disordered offenders OBJECTIVE Animal-assisted therapy ( AAT ) , most frequently used with dogs , is being used increasingly as an adjunctive alternative treatment for psychiatric patients .  AAT with larger animals , such as horses , may have unique benefits . In this r and omized controlled study , equine and canine forms of AAT were compared with st and ard treatments for hospitalized psychiatric patients to determine AAT effects on violent behavior and related measures . METHODS The study included 90 patients with recent in-hospital violent behavior or highly regressed behavior . Hospitalization at the 500-bed state psychiatric hospital was two months or longer ( mean 5.4 years ) . Participants were r and omly selected to receive ten weekly group therapy sessions of st and ardized equine-assisted psychotherapy ( EAP ) , canine-assisted psychotherapy ( CAP ) , enhanced social skills psychotherapy , or regular hospital care .  Participants ' mean age was 44 , 37 % were female , 76 % had diagnoses of schizophrenia or schizoaffective disorder , and 56 % had been committed involuntarily for civil or forensic reasons .  Violence-related incident reports filed by staff in the three months after study intake were compared with reports two months preintake . RESULTS Interventions were well tolerated . Analyses 
    Output:
    
The stronger evidence existed for patients with a SMI diagnosis receiving Cognitive Behavioural Therapy or modified Reasoning & Rehabilitation ( R&R ) .
Little evidence could be found for non-pharmacological , non-psychological interventions .
CONCLUSIONS The evidence for non-pharmacological interventions for reducing violence in this population is not conclusive .