Nonrestrictive aggression management interventions for adults with psychotic disorders: A systematic review

Objective: Aggression is a persistent clinical challenge, particularly prevalent in individuals with psychotic disorders. This systematic review aimed to compile current non-restrictive clinical interventions for aggression management in this population and identify those supported by a high level of evidence. Methods: A systematic literature search was conducted across Scopus/Elsevier/ClinicalKey/Embase, PubMed, Cochrane Library and CINAHL from 27 March to 10 May 2024. The review included randomized controlled trials (RCTs), non-randomized controlled trials and pre–post studies without a control group. From an initial pool of 575 records, 17 studies met the inclusion criteria for evidence assessment. Results: The 17 included studies comprised 15 RCTs, 1 non-randomized controlled trial and 1 pre–post study. Eleven studies demonstrated that the tested interventions were effective for aggression management, with evidence levels rated as high to moderate. Interventions were categorized into six groups: risk assessment ( n = 2), cognitive skills improvement interventions ( n = 2), social skills improvement interventions ( n = 1), environmental management ( n = 1), staff training ( n = 3) and multicomponent interventions ( n = 8). The findings underscore the necessity of multicomponent, holistic approaches over single-dimensional strategies. Conclusion: The review confirms the benefits of cognitive and social interventions and reinforces the effectiveness of staff de-escalation training. The positive results for sleep hygiene and therapeutic environment interventions support their integration into multidimensional aggression management protocols. Future research should employ larger RCTs to assess long-term sustainability, identify patient subgroups most likely to benefit from specific interventions and evaluate cost-effectiveness. This review is registered with PROSPERO (CRD42024579465).