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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
To test whether an intervention combining risk assessment and shared care
planning is associated with a reduction in violent and criminal
A cluster randomised controlled trial (Netherlands Trial Register number
NTR1042) was conducted in three outpatient 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.
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).
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.
A prognosis serves important functions for the management of common mental disorders in primary care.
To establish the accuracy of the general practitioner's (GP) prognosis.
The agreement between GP prognosis and observed course was determined for 138 cases of ICD–10 depression and 65 of generalised anxiety disorder, identified among consecutive attenders of 18 GPs.
Modest agreement between GP prognosis and course was found, both for depression (κ=0.21) and generalised anxiety (κ=0.111). Better agreement (κ=0.45 for depression, and κ=0.33 for generalised anxiety) was observed between the course and predictions from a statistical model based on information potentially available to the GP at the time the prognosis was made. This model assesses attainable performance for GPs.
General practitioners do a fair job in predicting the 1-year course of depression and generalised anxiety. Even so, their performance falls significantly short of attainable performance.
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