Psychotherapy for forensic psychiatric patients diagnosed with schizophrenia or schizoaffective disorders: a mixed methods systematic review

Most forensic psychiatric patients are diagnosed with schizophrenia or schizoaffective disorder. Psychotherapy is recognized as an important part of treatment for this patient population, yet no clinical guidelines exist. This mixed-method systematic review aimed to evaluate the scope, quality, and findings of psychotherapy research involving this population. Following the Joanna Briggs Institute methodology, thirteen studies were included after critical appraisal. A convergent-segregated synthesis approach was used due to heterogeneity in study designs and outcomes. Only two studies provided sufficient qualitative data for formal synthesis, while the remaining studies were narratively summarized. Meta-analysis was not feasible due to methodological heterogeneity and small sample sizes. Most studies examined cognitive-behavioral or skills-based interventions, suggesting potential improvements in social functioning, psychiatric symptoms, and reductions in violence. However, these findings were largely derived from small, non-controlled studies. A smaller number of studies have explored music and art therapies, suggesting potential benefits for negative symptoms and self-narrative, though the evidence remains limited. High-quality research, including patient perspectives, women, and the phenomena of the working alliance, is critical to develop the evidence base for forensic psychiatric patients who are diagnosed with schizophrenia or schizoaffective disorder.