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Tijdschrift voor Psychiatrie 54 (2012) 9, 797 - 806

Review article

Managing aggression in a forensic psychiatric unit for adolescents: literature review and clinical implementation

S. Tremmery, A. de Decker, M. De Hert, J. De Varé, M. Danckaerts

background Aggressive incidents are part and parcel of everyday life in a forensic psychiatric unit for adolescents.
aim To review the literature about the prevalence of aggressive incidents and about aggression management policy in (forensic) child and adolescent psychiatry and to explain and elaborate the aggression management protocol in a newly established unit.
method The literature was reviewed systematically using PubMed and Psycinfo in order to locate studies in English and Dutch published since 1990.
results Only 10 publications reported prevalence data on aggressive incidents in child or adolescent psychiatric units. Literature about concrete policy guidelines was almost non-existent. 27% to 78% of the youngsters had been involved in some kind of aggression. The lack of clear definitions and the differences in the research designs made a reliable comparison impossible.
conclusion To date, there is no evidence that a greater number of aggressive incidents occur in a forensic psychiatric unit for adolescents than in a regular adolescent psychiatric unit. Further research into both the prevalence and the characteristics of incidents is required in order to provide cues for a good policy. This policy will need to include structural and relational security measures that are firmly supported by the systematic registration of incidents and by continuous risk assessment.

keywords adolescents, aggression, forensic psychiatry, management, prevalence