The predictive validity and temporal characteristics of the HCR-20v3 for inpatient violence in forensic inpatient settings. An international study.

Aggression and violence are common day to day problems in psychiatric settings. However, the optimal means of assessing that risk remains unclear. In the context of that uncertainty many tools have evolved, among which the HCR-20 is one of the most globally accepted, though many questions remain about its performance, how and when it should be deployed and how it can be most effectively used. In this 12 month follow up study of 210 forensic psychiatric inpatients with a diagnosis of a schizophrenia spectrum disorder we explored these issues. We found that the performance of the HCR-20v3, especially its Total score, performed well up to 6 months after it was rated but its performance deteriorated after that. Repeating the HCR-20v3 at 6 months stabilised the risk assessment and led to improved performance in the second months over and above the first rating. The HCR-20v3 was good at identifying those subjects at low risk of violence over 6 months of follow up in a forensic inpatient setting. The real-world implications of this study are that the HCR-20v3 is an effective means of identifying patient at low risk of violence, but it should be reassessed every 6 months.

Metabolic syndrome in patients who have been subjected to isolation security measures and treated with atypical antipsychotics. / Zespól metaboliczny u pacjentów realizujacych izolacyjny srodek zabezpieczajacy, leczonych atypowymi lekami przeciwpsychotycznymi.

OBJECTIVES: The main aim of the study was to assess the incidence of metabolic syndrome and its individual components in patients subject to a confinement measure, treated with antipsychotics in mono - or polytherapy. Additional objectives included the analysis of associations between the occurrence of metabolic syndrome and patients' age, psychiatric diagnosis, overweight or obesity, and the presence of addictions to psychoactive substances. METHODS: The study involved 61 patients of the Department of Forensic Psychiatry, including 9 women and 52 men, subject to a confinement measure from September 2019 to August 2021. All parameters of metabolic syndrome and BMI were measured twice, at the beginning of the stay at the Department and after six months of treatment with atypical antipsychotics. Appropriate statistical comparative analyses were then performed. RESULTS: There was no relationship between the occurrence of metabolic syndrome and the age of the subjects, medical diagnosis, addiction to psychoactive substances, including smoking. It has not been confirmed that the chronic use of atypical antipsychotics with parallel prophylactic and health-promoting effects in conditions of confinement leads to the development of metabolic syndrome and worsens its symptoms, apart from a marked increase in waist circumference and an increase in BMI. CONCLUSIONS: Systematic measurements of BMI and waist circumference during treatment with atypical antipsychotics may be accurate tools in assessing the risk of metabolic syndrome. Long-term confinement hospitalizations should include psychoeducational nterventions aimed at minimizing metabolic complications of pharmacotherapy.

Difference between forensic patients with schizophrenia spectrum disorders in Italy and other European countries: Results of the EU-VIORMED project.

BACKGROUND: There has been a substantial change in the law on the provision of secure health services for offender-patients in Italy, a country currently with the lowest general psychiatry bed availability per head of the population in Europe, raising questions about possible differences in offender-patient admissions between European countries. AIMS: In this multicentre case-control study, our aim was to compare the socio-demographic, clinical and criminological characteristics of a sample of Italian forensic in-patients with schizophrenia or similar psychosis with patients in a similar diagnostic range in specialist in-patient services elsewhere in Europe. METHODS: Secure hospital unit in-patients with psychosis were recruited across five European countries (Italy, Austria, Germany, Poland and England). Consenting patients were interviewed by researchers and assessed using a multidimensional standardised process. Within country similarities between Austria, Germany, Poland and England were confirmed. RESULTS: Overall, 39 Italian participants had had fewer years of education than the 182 patients in the other countries and were less likely to have ever had skilled or professional employment. The Italian patients had been older at first contact with any mental health services than the other Europeans. Diagnosed comorbidity rates were similar, but the Italian group reported higher levels of disability. Although the other European forensic patients were more likely to be undergoing treatment at the time of their index offence, they were also more likely to have been poorly compliant with treatment. The rate of suicide-related behaviours was significantly lower among the Italian patients than among the others. CONCLUSIONS: Notwithstanding similar diagnoses, important differences emerged between patients in Italian forensic mental health resident services and those in four other European countries, some possibly reflecting less access to earlier relevant services in Italy. Others, including lower disability ratings among the Italian patients and a lower rate of suicide-related behaviours, may indicate that the Italian reforms carry benefits. This is worthy of further evaluation.

RISK aversion in Italian forensic and non-forensic patients with schizophrenia spectrum disorders.

BACKGROUND: Goal-directed decision-making is a central component of the broader reward and motivation system, and requires the ability to dynamically integrate both positive and negative feedback from the environment in order to maximize rewards and minimize losses over time. Altered decision-making processes, in which individuals fail to consider the negative consequences of their decisions on both themselves and others, may play a role in driving antisocial behaviour. AIM: The main study aim was to investigate possible differences in loss and risk aversion across matched patients, all with a schizophrenia spectrum disorder (SSD), but who varied according to whether they had a history of serious interpersonal violence or not, and a sample of healthy controls with no history of violence. RESULTS: The sample included 14 forensic and 21 non-forensic patients with SSD, and 41 healthy controls. Among the three decision-making variables under investigation, risk aversion was the only significant predictor of membership of the three groups, with greater risk aversion among non-forensic patients with SSD compared to healthy controls. No differences were observed across groups in loss aversion and choice consistency. CONCLUSIONS: This evidence suggests a new potential treatment target for rehabilitative measures aimed at achieving functional improvements in patients with SSD by selectively leveraging the neuro-cognitive processing of reward.

Exposure to violence in childhood and risk of violence in adult schizophrenia: Results from a multinational study.

This study investigated the connection between childhood violence exposure and violent behavior in adults with schizophrenia spectrum disorders (SSDs). The case-control study included 398 SSD patients: 221 cases with a history of severe interpersonal violence in the past and 177 controls with no history of violence. The findings indicated that cases were significantly more likely to report childhood exposure to all forms of witnessed or personally sustained violence both within and outside the family, with those who had witnessed intra-familial violence being more likely to assault a family member in adulthood. Cases reported exposure to violence before the age of 12 years significantly more frequently than controls, and those with early-life violence exposure were significantly more likely to report that they were in a state of intense anger when they behaved violently. A dose-response relationship was observed, with evidence of an increased risk of later violence when the exposure occurred before the age of 12 and an increased likelihood of intrafamilial violence. The evidence suggests that childhood violence exposure was associated with an increased risk of violent behavior in adult SSD patients, and early exposure was linked to an increased likelihood of physical violence occurring in states of intense anger.

Highly varying concepts and capacities of forensic mental health services across the European Union.

Introduction: There is wide variation in the processes, structures and treatment models for dealing with mentally disordered offenders across the European Union. There is a serious lack of data on population levels of need, national service capacities, or treatment outcome. This prevents us from comparing the different management and treatment approaches internationally and from identifying models of good practice and indeed what represents financial efficiency, in a sector that is universally needed. Methods: From March 2019 till January 2020 we surveyed forensic psychiatric experts from each European Union Member State on basic concepts, service capacities and indicators for the prevalence and incidence of various forensic psychiatric system components. Each expert completed a detailed questionnaire for their respective country using the best available data. Results: Finally, 22 EU Member States and Switzerland participated in the survey. Due to the frequent lack of a clear definition of what represented a forensic psychiatric bed, exact numbers on bed availability across specialized forensic hospitals or wards, general psychiatric hospitals or prison medical wards were often unknown or could only be estimated in a number of countries. Population-based rates calculated from the survey data suggested a highly variable pattern of forensic psychiatric provision across Europe, ranging from 0.9 forensic psychiatric beds per 100,000 population in Italy to 23.3 in Belgium. Other key service characteristics were similarly heterogeneous. Discussion: Our results show that systems for detaining and treating mentally disordered offenders are highly diverse across European Union Member States. Systems appear to have been designed and reformed with insufficient evidence. Service designers, managers and health care planners in this field lack the most basic of information to describe their systems and analyse their outcomes. As a basic, minimum standardized national reporting systems must be implemented to inform regular EU wide forensic psychiatry reports as a prerequisite to allow the evaluation and comparison of the various systems to identify models of best practice, effectiveness and efficiency.

A multinational case-control study comparing forensic and non-forensic patients with schizophrenia spectrum disorders: the EU-VIORMED project.

BACKGROUND: The relationship between schizophrenia and violence is complex. The aim of this multicentre case-control study was to examine and compare the characteristics of a group of forensic psychiatric patients with a schizophrenia spectrum disorders and a history of significant interpersonal violence to a group of patients with the same diagnosis but no lifetime history of interpersonal violence. METHOD: Overall, 398 patients (221 forensic and 177 non-forensic patients) were recruited across five European Countries (Italy, Germany, Poland, Austria and the United Kingdom) and assessed using a multidimensional standardised process. RESULTS: The most common primary diagnosis in both groups was schizophrenia (76.4%), but forensic patients more often met criteria for a comorbid personality disorder, almost always antisocial personality disorder (49.1 v. 0%). The forensic patients reported lower levels of disability and better social functioning. Forensic patients were more likely to have been exposed to severe violence in childhood. Education was a protective factor against future violence as well as higher levels of disability, lower social functioning and poorer performances in cognitive processing speed tasks, perhaps as proxy markers of the negative syndrome of schizophrenia. Forensic patients were typically already known to services and in treatment at the time of their index offence, but often poorly compliant. CONCLUSIONS: This study highlights the need for general services to stratify patients under their care for established violence risk factors, to monitor patients for poor compliance and to intervene promptly in order to prevent severe violent incidents in the most clinically vulnerable.

Letter to Editor. Position of the Polish Psychiatric Association on the use of benzodiazepine derivatives and drugs with a similar mechanism of action in the treatment of mental disorders. / List do Redakcji. Stanowisko Polskiego Towarzystwa Psychiatrycznego w sprawie stosowania pochodnych benzodiazepiny i leków o podobnym mechanizmie dzialania w leczeniu zaburzen psychicznych.

no summary.

Decision-making and risk-taking in forensic and non-forensic patients with schizophrenia spectrum disorders: A multicenter European study.

Studies of patients with schizophrenia and offenders with severe mental disorders decision-making performance have produced mixed findings. In addition, most earlier studies have assessed decision-making skills in offenders or people with mental disorders, separately, thus neglecting the possible additional contribution of a mental disorder on choice patterns in people who offend. This study aimed to fill this gap by comparing risk-taking in patients with schizophrenia spectrum disorders (SSD), with and without a history of serious violent offending assessing whether, and to what extent, risk-taking represents a significant predictor of group membership, controlling for their executive skills, as well as for socio-demographic and clinical characteristics. Overall, 115 patients with a primary diagnosis of SSD were recruited: 74 were forensic patients with a lifetime history of severe interpersonal violence and 41 were patients with SSD without such a history. No significant group differences were observed on psychopathological symptoms severity. Forensic generally displayed lower scores than non-forensic patients in all cognitive subtests of the Brief Assessment of Cognition in Schizophrenia (except for the "token motor" and the "digit sequencing" tasks) and on all the six dimensions of the Cambridge Gambling Task, except for "Deliberation time", in which forensic scored higher than non-forensic patients. "Deliberation time" was also positively, although weakly correlated with "poor impulse control". Identifying those facets of impaired decision-making mostly predicting offenders' behaviour among individuals with mental disorder might inform risk assessment and be targeted in treatment and rehabilitation protocols.

Polish Psychiatric Association diagnostic and therapeutic management guidelines for patients with early-onset schizophrenia. / Rekomendacje Polskiego Towarzystwa Psychiatrycznego w zakresie postepowania diagnostycznego i terapeutycznego u chorych ze schizofrenia o wczesnym poczatku.

Early onset of schizophrenia (before the age of 18 years) is associated with a higher risk of delayed or missed diagnosis, more severe course of the disease, and an increased susceptibility to adverse reactions to antipsychotic drugs. The objective of this paper is to present the recommendations for the diagnostic and therapeutic management of patients with early-onset schizophrenia, developed on the basis of a literature review and a consensus of a group of experts working with schizophrenia therapy. The formal criteria that must be met to diagnose schizophrenia are the same for children and adults. Early-onset schizophrenia must be thoroughly differentiated from uni - or bipolar affective disorder, autism-spectrum disorders (ASDs) and anxiety disorder. Diagnostic assessment for psychotic disorders is also necessary in the case of abnormal, destructive or aggressive behaviour, or self-harm. The mainstay of schizophrenia treatment is pharmacological therapy, which is used in the treatment of acute episodes and in maintenance treatment - prevention of relapses. However, the use of pharmacological interventions in children and adolescents only to reduce the risk of psychosis development is not justified. Antipsychotic agents significantly differ by their tolerance profile and clinical efficacy. Second-generation antipsychotic agents approved for the treatment of early-onset schizophrenia - aripiprazole, lurasidone and paliperidone - enable its effective and safe treatment. The necessary complement to pharmacological therapy is non-pharmacological interventions that should be adapted to the patient's age, cognitive abilities, disease stage and the needs of the whole family.

Subjective mental deterioration of healthcare workers during the first wave of the COVID-19 pandemic in Poland. / Subiektywne pogorszenie stanu psychicznego pracowników sektora opieki medycznej w czasie pierwszej fali pandemii COVID-19 w Polsce.

OBJECTIVES: The presented study is aimed at determining the subjective psychological reaction to the outbreak of pandemic in healthcare workers and is part of a wider research project covering successive waves of increasing number of SARS-CoV-2 infections during the COVID-19 pandemic in Poland. METHODS: 664 respondents completed the anonymous online questionnaire in the period from March 12, 2020 to May 3, 2020. This is the period of the first lockdown in Poland. Data were collected using the snowball method (employees passed the questionnaire over the Internet to subsequent groups of employees in subsequent healthcare units). RESULTS: The outbreak of pandemic had varying impact on the well-being of 96.7% of respondents. Subjectively perceived stress of varying intensity was reported by 97.3% of them, low mood was reported in 19.0%, and anxiety in 14.1% of the respondents. These results and other features of the psychological reaction (including sleep problems) to overload in healthcare workers may indicate mental deterioration in the first weeks of pandemic. CONCLUSIONS: The results obtained in the study group may encourage further analyzes of healthcare workers' mental state and contribute to discussion on the COVID-19 pandemic.

Long-term forensic psychiatric inpatient treatment - review of the selected literature and the analysis of data from the medium secured forensic psychiatry unit. / Wieloletnie detencje psychiatryczne ­ przeglad wybranego pismiennictwa i analiza danych z oddzialu psychiatrii sadowej o wzmocnionym stopniu zabezpieczenia.

OBJECTIVES: The aim of this study was to perform an analysis of the risk factors of long-term psychiatric detention, defined as a stay in forensic institution exceeding respectively 60 and 84 months, based on data obtained from 150 patients from medium secure forensic psychiatry unit. The discussion was preceded by an analysis of the available literature in this field. The sociodemographic factors, the course of the mental disorder, the characteristic of committed criminal acts, aggressive or self-destructive behavior and the clinical characteristic of the illness in the last 6 months of psychiatric detention were analyzed. METHODS: A pilot study was based on a retrospective analysis of data from medical records and psychiatric experts' opinions of a cross-sectional nature. Due to the variables' characteristic, the Student's t-tests, Spearman's correlation and the Kruskal-Wallis rank ANOVA were used. RESULTS: Risk of long-term hospitalization significantly correlated with factors related to the course of the last 6 months of inpatient treatment, including the mental state of patients, the occurrence of aggressive behaviors and the response to pharmacological treatment. There was no significant effect of demographic factors or coexisting addiction to alcohol and psychoactive substances. The risk of long-term psychiatric detention increased with the duration of the illness. There were no correlations with the age of the patients at the time of admission nor number of detentions. The nature of the diagnosis was also not found to be a risk factor. CONCLUSIONS: Our study is the first systematic attempt to assess the risk factors of long-term psychiatric detention in a group of patients of forensic psychiatry centers in Poland. We hope that the presented results will rise a discussion on the shape of psychiatric care in Poland and encourage further research in this area, as well as they will contribute to the optimization of the treatment process.

Neurocognition and social cognition in patients with schizophrenia spectrum disorders with and without a history of violence: results of a multinational European study.

OBJECTIVE: Neurocognitive impairment has been extensively studied in people with schizophrenia spectrum disorders and seems to be one of the major determinants of functional outcome in this clinical population. Data exploring the link between neuropsychological deficits and the risk of violence in schizophrenia has been more inconsistent. In this study, we analyse the differential predictive potential of neurocognition and social cognition to discriminate patients with schizophrenia spectrum disorders with and without a history of severe violence. METHODS: Overall, 398 (221 cases and 177 controls) patients were recruited in forensic and general psychiatric settings across five European countries and assessed using a standardized battery. RESULTS: Education and processing speed were the strongest discriminators between forensic and non-forensic patients, followed by emotion recognition. In particular, increased accuracy for anger recognition was the most distinctive feature of the forensic group. CONCLUSIONS: These results may have important clinical implications, suggesting potential enhancements of the assessment and treatment of patients with schizophrenia spectrum disorders with a history of violence, who may benefit from consideration of socio-cognitive skills commonly neglected in ordinary clinical practice.

Neuropathological Changes in the Brains of Suicide Killers.

BACKGROUND: Homicide combined with subsequent suicide of the perpetrator is a particular form of interpersonal violence and, at the same time, a manifestation of extreme aggression directed against oneself. Despite the relatively well-described individual acts of homicide and suicide, both in terms of psychopathology and law, acts of homicide and subsequent suicide committed by the same person are not well-studied phenomena. The importance of emotional factors, including the influence of mental state deviations (psychopathology), on this phenomenon, is discussed in the literature, but still there is relatively little data with which to attempt neuropathological assessments of the brains of suicide killers. This paper is dedicated to the issue based on the neuropathological studies performed. METHODS: We analyzed a group of murder-suicides using histochemical and immunohistochemical methods. RESULTS: The results of our research indicate the presence of neurodegenerative changes including multiple deposits of ß-amyloid in the form of senile/amyloid plaques and perivascular diffuse plaques. CONCLUSIONS: Neurodegenerative changes found in the analyzed brains of suicide killers may provide an interesting starting point for a number of analyses. The presence of neurodegenerative changes at such a young age in some murderers may suggest preclinical lesions that affect cognitive functions and are associated with depressed moods.

Pharmacological treatment of a depressive episode and recurrent depressive disorder - guidelines of the Polish Psychiatric Association and the National Consultant for Adult Psychiatry. / Leczenie farmakologiczne epizodu depresji i zaburzen depresyjnych nawracajacych ­ wytyczne Polskiego Towarzystwa Psychiatrycznego i Konsultanta Krajowego ds. Psychiatrii Doroslych.

Under the auspices of the Polish Psychiatric Association and the National Consultant in Psychiatry, on the basis of analysis of international guidelines, the expert group consisting of psychiatrists and an epidemiologist compiled recommendations for the treatment of adepressive episode and recurrent depressive disorder. The recommendations take into account the information that the patient should receive before starting the treatment, the selection criteria for the treatment method and the choice of the antidepressant, the method of assessing the efficacy of treatment, treatment monitoring, and the duration of treatment. Formulating the recommendations, the experts analyzed the source data for their applicability in Poland. The current recommendations of scientific societies and an analysis of the literature on the treatment of depressive episodes and recurrent depressive disorder broken down by the treatment of acute episodes and maintenance treatment, as well as the recommendations on the method of creating guidelines have been taken into account. Furthermore, the guidelines developed in collaboration with the Supreme Medical Council and the Polish Psychiatric Association, entitled: "Diagnostic work-up and treatment of depression in adults - guidelines for family physicians", and recommendations of theNationalConsultantin Adult Psychiatry have been taken into account. The recommendations were discussed among the experts and accepted by the General Board of the Polish Psychiatric Association. Subsequently, the recommendations were modified in line with the Board's commentsand endorsed by the Association for use in the management of patients with depression in Poland.

Longer than prison? A comparison of length of stay in a medium security hospital and prison for perpetrators of violent crimes other than homicide or attempted homicide.

BACKGROUND: Concerns have been raised that people detained in secure hospitals after a criminal act spend longer in a locked institution than people sent to prison for similar offending, but research evidence is scarce and conflicting. AIMS: To compare the length of secure hospitalisation of people convicted of crimes for which flexible sentencing is allowed with length of time in prison for people serving a prison sentence for similar crimes who were not found mentally ill. METHODS: A records-based, retrospective study was conducted comparing length of stay of all inpatients in one medium security hospital in Poland, hospitalised between 2014 and 2018, who had been convicted of any interpersonal crime other than homicide or attempted homicide, and data on all sentenced prisoners in Poland on 09.05.2018 convicted of a similar range of offences. Homicide was excluded because, in Poland, it usually attracts a fixed sentence-a life sentence until the 1970s and currently a 25-year imprisonment-so disrupting comparisons. RESULTS: Eighty-two patients completed their secure hospital stay within the study period or were still hospitalised at the census point 09.05.2018, only 10 of them women. Male patients convicted of stalking or similar threatening offence or 'mistreatment' spent, on average, almost twice as long confined to hospital than men sentenced to imprisonment spent in prison (28.8 months, respectively). By contrast, men hospitalised after sex offences were confined for over three years less than those sentenced to prison. Only bodily harm offences attracted comparable lengths of stay in hospital and prison. CONCLUSIONS: Our findings confirm significant disparities in length of time spent in a closed institution after offences of serious interpersonal violence, according to whether that institution was prison or hospital, but not all in the same direction. Next steps should explore reasons for this and relative longer-term outcomes.

A Systematic Review of Non-pharmacological Strategies to Reduce the Risk of Violence in Patients With Schizophrenia Spectrum Disorders in Forensic Settings.

Background: The purpose of this systematic review is to systematically investigate which non-pharmacological interventions are effective in reducing violence risk among patients with schizophrenia spectrum disorders (SSD) in forensic settings. Methods: Six electronic data bases were searched. Two researchers independently screened 6,003 abstracts resulting in 143 potential papers. These were analyzed in detail by two independent researchers yielding 10 articles that could be used. Results: Of the 10 articles, four were non-randomized controlled trials, three were pre-post studies without controls, and one was observational. Only two studies applied a randomized controlled trial design. Cognitive behavioral treatment programs were investigated in three studies. A broad range of other interventions were studied. Often outcome measures were specific to each study and sample sizes were small. Frequently, important methodological information was missing from the papers. It was not possible to carry out a meta-analysis due to the heterogeneity of the study designs and outcome measures. Conclusion: Because of methodological limitations it is difficult to draw firm conclusions about the effectiveness of non-pharmacological interventions to reduce the risk of violence in patents with SSD in forensic psychiatry settings. Studies applying better methods in terms of study design, sample sizes and outcome measures are urgently needed.

Treatment resistance and prolonged length of stay among schizophrenia inpatients in forensic institutions.

Patients suffering from schizophrenia spectrum disorders are the largest group of forensic inpatients worldwide, therefore the identification of factors that influence how long service users experiencing schizophrenia spend in forensic hospitals is one of the most important research areas in forensic psychiatry. Methods: Analysis of data of 87 schizophrenia inpatients, hospitalized in a medium secure forensic unit. Results: Mental disorders among family members, alcohol or substance dependence diagnosis, the severity of the criminal behavior demonstrated by homicide/homicide attempts and features of treatment resistance as persistent psychotic symptoms and current treatment with >1 antipsychotics was proven to influence the length of stay (LoS).

Pharmacological interventions to reduce violence in patients with schizophrenia in forensic psychiatry.

BACKGROUND: The purpose was to systematically investigate which pharmacological strategies are effective to reduce the risk of violence among patients with Schizophrenia Spectrum Disorders (SSD) in forensic settings. METHODS: For this systematic review six electronic data bases were searched. Two researchers independently screened the 6,003 abstracts resulting in 143 potential papers. These were then analyzed in detail by two independent researchers. Of these, 133 were excluded for various reasons leaving 10 articles in the present review. RESULTS: Of the 10 articles included, five were merely observational, and three were pre-post studies without controls. One study applied a matched case-control design and one was a non-randomized controlled trial. Clozapine was investigated most frequently, followed by olanzapine and risperidone. Often, outcome measures were specific to the study and sample sizes were small. Frequently, relevant methodological information was missing. Due to heterogeneous study designs and outcomes meta-analytic methods could not be applied. CONCLUSION: Due to substantial methodological limitations it is difficult to draw any firm conclusions about the most effective pharmacological strategies to reduce the risk of violence in patents with SSD in forensic psychiatry settings. Studies applying more rigorous methods regarding case-definition, outcome measures, sample sizes, and study designs are urgently needed.

Polish Psychiatric Association consensus statement on non-pharmacological methods in the treatment of negative symptoms of schizophrenia. / Stanowisko grupy roboczej PTP na temat stosowania metod niefarmakologicznych w leczeniu objawów negatywnych schizofrenii.

This consensus statement has been prepared by a group of experts consisting of professionals with long experience in the treatment of psychiatric disorders, who were appointed by the Management Board of the Polish Psychiatric Association. The evaluation involved the analysis of literature databases and information derived from meta-analyses of these data for years 2010-2020. The searched publications were in English, German and Polish language versions and involved interventions performed in groups of adult patients. The efficacy of nonpharmacological methods applied for treatment of negative symptoms of schizophrenia were compared with effects of adifferent treatment/combined treatment/a group with no intervention. When formulating the recommendations, the experts analysed the source data in terms of their application in the Polish conditions. The current recommendations of academic societies and literature on the treatment of schizophrenia with predominant negative symptoms were taken into account. The experts included items that involved a comparison of a study group in terms of non-pharmacological interventions, and pharmacologically treated cases were taken into account only when divisions were made into standard treatment and additional intervention. The results were divided into 7 sections: 1. Psychoeducation, 2. Psychotherapy (individual, group and family therapy), 3. Psychiatric rehabilitation, 4. Emotional intelligence, social skills and mindfulness training, 5. Cognitive remediation/rehabilitation, cognitive training, 6. Clinical efficacy of physical activity, behavioral activation and metacognitive training, 7. Other rehabilitation methods (including biological methods). The recommendations were debated by experts, approved by the Management Board of the Polish Psychiatric Association,and -upon consideration of the submitted comments - adopted as aconsensus statement of the Association with the recommendation of their application in the treatment of schizophrenic patients in Poland.