The number of beds in forensic psychiatry has increased more than two-fold since 1990 in many countries, mostly due to an increasing number of admitted male patients with psychotic disorders. Most of these patients had previous admissions to general psychiatric units.

To develop a manual for interventions aiming on the prevention of violence based on cognitive behavioural therapy and to test its feasibility.

A manual comprising of 11 different domains of possible interventions was developed. For each patient, the three most relevant domains should be identified. A pilot study was conducted in two psychiatric hospitals. Included patients should receive two sessions as in-patients and consecutively three more as out-patients.

Out of 368 male patients with a diagnosis of a schizophrenic or schizoaffective disorder, 89 (24.2%) had a relevant history of violence. Only 15 (17%) could be recruited for the study, 13 (14.6% of eligible patients) completed the intervention. A considerable proportion refused to participate. The manual was considered to be applicable and relevant. Domains used most frequently were anger management, substance abuse, and medication adherence.

The intervention based on a flexible manual and five sessions was feasible and well accepted by participating patients. However, it turned out to be difficult to recruit this group of patients for an intervention programme and for a study. To conduct a randomised controlled trial, a screening of about 4.000 patients with schizophrenia will be necessary.