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Babcock JC, Kini S, Godfrey DA, Rodriguez L. Differential Treatment Response of Proactive and Reactive Partner Abusive Men: Results from a Laboratory Proximal Change Experiment. PSYCHOSOCIAL INTERVENTION 2024; 33:43-54. [PMID: 38298213 PMCID: PMC10826976 DOI: 10.5093/pi2024a2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 10/09/2023] [Indexed: 02/02/2024]
Abstract
Objective: The current study reexamines data from Babcock et al. (2011) proximal change experiment to discern the differential utility of two communication skills-based interventions for proactive and reactive partner violence offenders. Method: Partner violent men were randomly assigned to the Editing Out the Negative skill, the Accepting Influence skill, or to a placebo/timeout and reengaged in a conflict discussion with their partners. Proactivity was tested as a moderator of immediate intervention outcomes. The ability to learn the communication skills, changes in self-reported affect, observed aggression, and psychophysiological responding were examined as a function of proactivity of violence. Results: Highly proactive men had some difficulty learning the Accepting Influence skill and they responded poorly to this intervention. They responded positively to the Editing Out the Negative technique, with less aggression, more positive affect, and lower heart rates. Low proactive (i.e., reactive) men tended to feel less aggressive, more positive, and less physiologically aroused after completing the Accepting Influence technique. Conclusions: This study lends support for tailoring batterer interventions specific to perpetrator characteristics.
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Affiliation(s)
| | - Sheetal Kini
- The Lighthouse ArabiaUAEThe Lighthouse Arabia, UAE;
| | | | - Lindsey Rodriguez
- University of FloridaGainesvilleFLUSAUniversity of Florida, Gainesville, FL, USA
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2
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van Beek J, Meijers J, Scherder EJA, Harte JM. Aggressive Incidents by Incarcerated People With Psychiatric Illness and Their Relationship With Psychiatric Symptoms. JOURNAL OF FORENSIC NURSING 2023; 19:E30-E38. [PMID: 37590946 DOI: 10.1097/jfn.0000000000000424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
AIM A prospective design was used to investigate the relationship of current psychiatric symptoms of incarcerated people with serious mental illness (SMI) and aggressive behavior on a penitentiary ward for crisis intervention. METHODS One hundred sixty detainees with SMI, detained in a high-security penitentiary psychiatric facility, were screened every 2 weeks with the Brief Psychiatric Rating Scale-Extended (BPRS-E) by trained clinicians, to ensure that the data on psychiatric symptoms were up-to-date. Aggressive behavior was registered with the Staff Observation Aggression Scale-Revised. A binary logistic regression analysis was performed to examine the relationships between factor scores of the BPRS-E and aggressive behavior. RESULTS Significant relationships between the BPRS-E factor hostility, antisocial traits, and aggressive incidents were found, but not between the positive symptoms or manic factor scores and aggressive incidents. DISCUSSION Symptoms of SMI measured with the BPRS-E did not help to explain the occurrence of aggressive behavior. This is not in line with what is commonly found. The implication is that it can be expected that this population will display aggressive behavior but that symptoms do not help in predicting when this will occur. In addition, hostility and antisocial traits were related to aggressive behavior. For this specific population, an interactional approach might be more effective in the management of aggression than treatment of symptoms of SMI.
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Affiliation(s)
| | | | - Erik J A Scherder
- Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam
| | - Joke M Harte
- Department of Criminal Law and Criminology, Faculty of Law, Vrije Universiteit Amsterdam
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3
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de Girolamo G, Iozzino L, Ferrari C, Gosek P, Heitzman J, Salize HJ, Wancata J, Picchioni M, Macis A. A multinational case-control study comparing forensic and non-forensic patients with schizophrenia spectrum disorders: the EU-VIORMED project. Psychol Med 2023; 53:1814-1824. [PMID: 34511148 PMCID: PMC10106295 DOI: 10.1017/s0033291721003433] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/30/2021] [Accepted: 08/02/2021] [Indexed: 01/17/2023]
Abstract
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.
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Affiliation(s)
- Giovanni de Girolamo
- Unit of Epidemiological Psychiatry and Evaluation, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Laura Iozzino
- Unit of Epidemiological Psychiatry and Evaluation, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Clarissa Ferrari
- Unit of Statistics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Pawel Gosek
- Department of Forensic Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Janusz Heitzman
- Department of Forensic Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Hans Joachim Salize
- Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Johannes Wancata
- Clinical Division of Social Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Marco Picchioni
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- St Magnus Hospital, Haslemere, Surrey, UK
| | - Ambra Macis
- Unit of Statistics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
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4
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Bell C, Tesli N, Gurholt TP, Rokicki J, Hjell G, Fischer-Vieler T, Melle I, Agartz I, Andreassen OA, Ringen PA, Rasmussen K, Dahl H, Friestad C, Haukvik UK. Psychopathy subdomains in violent offenders with and without a psychotic disorder. Nord J Psychiatry 2022; 77:393-402. [PMID: 36260740 DOI: 10.1080/08039488.2022.2128869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Violence in psychosis has been linked to antisocial behavior and psychopathy traits. Psychopathy comprises aspects of interpersonal, affective, lifestyle, and antisocial traits which may be differently involved in violent offending by persons with psychotic disorders. We explored psychopathy subdomains among violent offenders with and without a psychotic disorder. METHODS 46 males, with a history of severe violence, with (n = 26; age 35.85 ± 10.34 years) or without (n = 20; age 39.10 ± 11.63 years) a diagnosis of a psychotic disorder, were assessed with the Psychopathy Checklist-Revised (PCL-R). PCL-R was split into subdomains following the four-facet model. Group differences in total and subdomain scores were analyzed with a general linear model with covariates. RESULTS Total PCL-R scores did not differ between the groups (p = 0.61, Cohen's d = 0.17). The violent offenders without psychotic disorders had higher facet 2 scores than the patient group with psychotic disorders (p = 0.029, Cohen's d = 0.77). Facet 1, 3, or 4 scores did not differ between the groups. Controlling for age did not alter the results. CONCLUSION Patients with a psychotic disorder and a history of severe violence have lower affective psychopathy scores than violent offenders without psychotic disorders. This observation may point toward distinct underlying mechanisms for violence and may provide a target for focused treatment and prevention.
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Affiliation(s)
- Christina Bell
- Department of Psychiatry, Oslo University Hospital, Oslo, Norway.,Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Natalia Tesli
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Tiril P Gurholt
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Jaroslav Rokicki
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Centre of Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway
| | - Gabriela Hjell
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatry, Østfold Hospital Trust, Graalum, Norway
| | - Thomas Fischer-Vieler
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Vestre Viken Hospital Trust, Division of Mental health and Addiction, Drammen Hospital, Drammen, Norway
| | - Ingrid Melle
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Ingrid Agartz
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway.,Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden.,Stockholm Health Care Services, Stockholm Region, Stockholm, Sweden
| | - Ole A Andreassen
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Petter Andreas Ringen
- Department of Psychiatry, Oslo University Hospital, Oslo, Norway.,Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Adult Psychiatry, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kirsten Rasmussen
- St.Olavs Hospital, Centre for Research and Education in Forensic Psychiatry, Trondheim, Norway.,Department of Psychology and Department of Mental Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Hilde Dahl
- St.Olavs Hospital, Centre for Research and Education in Forensic Psychiatry, Trondheim, Norway.,Department of Psychology and Department of Mental Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Christine Friestad
- Centre of Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway.,University College of Norwegian Correctional Service, Oslo, Norway
| | - Unn K Haukvik
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Adult Psychiatry, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Centre of Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway
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5
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Jung HY, Jung S, Bang M, Choi TK, Park CI, Lee SH. White matter correlates of impulsivity in frontal lobe and their associations with treatment response in first-episode schizophrenia. Neurosci Lett 2021; 767:136309. [PMID: 34736723 DOI: 10.1016/j.neulet.2021.136309] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 10/19/2021] [Accepted: 10/22/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND It is known that increased impulsivity in schizophrenia patients causes poor treatment outcomes by increasing cost, stigma, hospitalization, treatment challenge, and physical harm. Dysfunction in the prefrontal cortex appears to be involved in the impulsivity associated with schizophrenia; nonetheless, there is a dearth of research on specific white matter alterations in the prefrontal cortex related to impulsivity. METHODS We enrolled in the present study 119 first-episode schizophrenia patients. We measured their symptom severity at baseline and after eight weeks of treatment, using the positive and negative syndrome scale. We performed neuroimaging analysis using the Tract-Based Spatial Statistics program and by specifying the prefrontal white matter as a region of interest. RESULTS In voxel-wise correlational analysis, we observed white matter regions showing significant positive correlations with poor impulse control scores, in both the right dorsolateral prefrontal cortex and the right frontal pole region. The fractional anisotropy values of these areas correlated positively with symptom severity at baseline. Moreover, after eight weeks, treatment non responders showed significantly higher fractional anisotropy values in the same areas. CONCLUSIONS The results of the present study suggest that white matter tracts in the right dorsolateral prefrontal cortex and the right frontal pole may underlie dysfunctional impulse control and could be potential predictive markers for short-term treatment in patients with first-episode schizophrenia.
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Affiliation(s)
- Hye-Yeon Jung
- Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea; Department of Psychiatry, CHA Gumi Medical Center, CHA University, Gumi, Republic of Korea
| | - Sra Jung
- Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea; Department of Psychiatry, CHA Gumi Medical Center, CHA University, Gumi, Republic of Korea
| | - Minji Bang
- Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea; Department of Psychiatry, CHA Gumi Medical Center, CHA University, Gumi, Republic of Korea
| | - Tai Kiu Choi
- Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea; Department of Psychiatry, CHA Gumi Medical Center, CHA University, Gumi, Republic of Korea
| | - Chun Il Park
- Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea; Department of Psychiatry, CHA Gumi Medical Center, CHA University, Gumi, Republic of Korea.
| | - Sang-Hyuk Lee
- Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea; Department of Psychiatry, CHA Gumi Medical Center, CHA University, Gumi, Republic of Korea.
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6
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An Examination of the Performance of the interRAI Risk of Harm to Others Clinical Assessment Protocol (RHO CAP) in Inpatient Mental Health Settings. Psychiatr Q 2021; 92:863-878. [PMID: 33219429 DOI: 10.1007/s11126-020-09857-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/15/2020] [Indexed: 10/22/2022]
Abstract
We study violence risk prediction at St. Joseph's Healthcare Hamilton. Data from January 2016 to December 2017 have been anonymized and collected, for a total of 870 episodes of inpatient aggressions perpetrated by 337 patients. We examine the predictive performance of a clinical indicator embedded in a mandatory assessment tool for psychiatric facilities in Ontario, the Resident Assessment Instrument for Mental Health (RAI-MH): the Risk of Harm to Others Clinical Assessment Protocol (RHO CAP). The RHO CAP's performance is studied among two groups of patients. Moreover, an analysis of the most important risk factors associated with harmful incidents is presented. The RHO CAP has demonstrated a better performance in discriminating which patients were more at risk to commit some type of aggression than at identifying the risk of harm among those who will commit aggression.
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7
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Janah M, Hargiana G. Levels of stress and coping strategies in family caregivers who treat schizophrenic patients with risk of violent behavior. J Public Health Res 2021; 10. [PMID: 34060756 PMCID: PMC9309628 DOI: 10.4081/jphr.2021.2404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 05/13/2021] [Indexed: 11/25/2022] Open
Abstract
Background Violent behavior is one of the most common symptoms of people who have
schizophrenia. Caring for family members who have schizophrenia can be a
stressor for other family members. The stressors can be stressful for the
caregiver. Family caregivers require coping strategies to overcome the
stressors. This study aims to determine the relationship between stress
levels and coping strategies of family caregivers who treat schizophrenic
patients with a risk of violent behavior. Design and Methods The research design engaged crosssectional with the purposive sampling
technique by involving 87 caregiver families who who treat schizophrenic
patients. The data was collected by using the Perceived Stress Scale (PSS)
and Ways of Coping (WOC) questionnaires. This study was analyzed by
employing the Chi-Square test to determine the relationship between stress
levels and coping strategies in the caregiver family. Results This study shows that stress levels are not significantly associated with
coping strategies in family caregivers. Conclusion Good supports from health and social service professionals are required to
help family caregivers cope with their stressors well.
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Affiliation(s)
- Miftahul Janah
- Faculty of Nursing, Universitas Indonesia, Depok, West Java.
| | - Giur Hargiana
- Department of Mental Health Nursing, Faculty of Nursing, Universitas Indonesia, Depok, West Java.
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8
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Bottesi G, Candini V, Ghisi M, Bava M, Bianconi G, Bulgari V, Carrà G, Cavalera C, Conte G, Cricelli M, Ferla MT, Iozzino L, Macis A, Stefana A, de Girolamo G. Personality, Schizophrenia, and Violence: A Longitudinal Study: The Second Wave of the VIORMED Project. J Pers Disord 2021; 35:236-254. [PMID: 31609185 DOI: 10.1521/pedi_2019_33_436] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study investigated the association between maladaptive personality traits, personality disorders (PDs), schizophrenia, and the risk of aggressive behavior. Ninety-four patients with a history of violence and 92 patients with no history of violence underwent a multidimensional baseline assessment. Aggressive behavior was monitored during a 1-year follow-up through the Modified Overt Aggression Scale. The Violent group scored significantly higher than the Control group on the Millon Clinical Multiaxial Inventory (MCMI-III) Antisocial, Sadistic, Borderline, and Paranoid personality scales. Irrespective of any history of violence, patients with PD as a primary diagnosis displayed more aggressive behaviors than those with a primary diagnosis of schizophrenia during the follow-up. Furthermore, the most significant predictor of aggressive behaviors over time was endorsing a primary diagnosis of PD. Identifying the crucial risk factors for violent recidivism would contribute to reducing aggressive behavior in this population.
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Affiliation(s)
- Gioia Bottesi
- Department of General Psychology, University of Padova, Padova, Italy
| | - Valentina Candini
- Department of General Psychology, University of Padova, Padova, Italy.,Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Marta Ghisi
- Department of General Psychology, University of Padova, Padova, Italy
| | - Mattia Bava
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Giorgio Bianconi
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.,Department of Mental Health, ASST Ovest Milanese, Milano, Italy
| | - Viola Bulgari
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy.,Division of Psychiatry, University College London, London, UK
| | - Cesare Cavalera
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.,Department of Psychology, Catholic University of the Sacred Heart, Milano, Italy
| | - Giovanni Conte
- Department of Mental Health, ASST Spedali Civili of Brescia, Italy
| | - Marta Cricelli
- Department of Mental Health, Asst-Rhodense G. Salvini di Garbagnate, Milano, Italy
| | - Maria Teresa Ferla
- Department of Mental Health, Asst-Rhodense G. Salvini di Garbagnate, Milano, Italy
| | - Laura Iozzino
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Ambra Macis
- Unit of Statistics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Alberto Stefana
- Department of Mental Health, ASST Spedali Civili of Brescia, Italy
| | - Giovanni de Girolamo
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
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9
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Pathways to aggression and violence in psychosis without longstanding antisocial behavior: A review and proposed psychosocial model for integrative clinical interventions. Psychiatry Res 2020; 293:113427. [PMID: 32866792 DOI: 10.1016/j.psychres.2020.113427] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/19/2020] [Accepted: 08/23/2020] [Indexed: 11/22/2022]
Abstract
There is a need for a clearer understanding of the factors associated with increased risk of aggression and violence (AV) among people with psychosis and other severe mental illness (SMI) to guide effective prevention and intervention. The current article (1) reviews the literature regarding psychosocial factors associated with AV among individuals with psychosis and other SMI who do not have longstanding antisocial behaviors, (2) proposes an integrative psychosocial model of AV that can be practically applied, and (3) proposes appropriate evidence-based clinical interventions to reduce AV and facilitate recovery. We propose that increased risk for AV among people with psychosis is driven by anger, which is affected by a range of factors including victimization and situational stressors, social rejection or experiences of discrimination, anxious arousal, and hostile attribution bias related to psychosis. The cumulative effect of these systems is exacerbated by co-occurring substance misuse and increased impulsivity, particularly negative urgency. In consideration of the current psychosocial model and existing evidence-based interventions for AV in individuals with psychosis, we propose that trauma-informed interventions that integrate skills training in emotion regulation, social and interpersonal situations, cognitive restructuring and remediation, and modified prolonged exposure may demonstrate the most promise for this population.
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10
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Wong TY, Radua J, Pomarol-Clotet E, Salvador R, Albajes-Eizagirre A, Solanes A, Canales-Rodriguez EJ, Guerrero-Pedraza A, Sarro S, Kircher T, Nenadic I, Krug A, Grotegerd D, Dannlowski U, Borgwardt S, Riecher-Rössler A, Schmidt A, Andreou C, Huber CG, Turner J, Calhoun V, Jiang W, Clark S, Walton E, Spalletta G, Banaj N, Piras F, Ciullo V, Vecchio D, Lebedeva I, Tomyshev AS, Kaleda V, Klushnik T, Filho GB, Zanetti MV, Serpa MH, Penteado Rosa PG, Hashimoto R, Fukunaga M, Richter A, Krämer B, Gruber O, Voineskos AN, Dickie EW, Tomecek D, Skoch A, Spaniel F, Hoschl C, Bertolino A, Bonvino A, Di Giorgio A, Holleran L, Ciufolini S, Marques TR, Dazzan P, Murray R, Lamsma J, Cahn W, van Haren N, Díaz-Zuluaga AM, Pineda-Zapata JA, Vargas C, López-Jaramillo C, van Erp TGM, Gur RC, Nickl-Jockschat T. An overlapping pattern of cerebral cortical thinning is associated with both positive symptoms and aggression in schizophrenia via the ENIGMA consortium. Psychol Med 2020; 50:2034-2045. [PMID: 31615588 DOI: 10.1017/s0033291719002149] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Positive symptoms are a useful predictor of aggression in schizophrenia. Although a similar pattern of abnormal brain structures related to both positive symptoms and aggression has been reported, this observation has not yet been confirmed in a single sample. METHOD To study the association between positive symptoms and aggression in schizophrenia on a neurobiological level, a prospective meta-analytic approach was employed to analyze harmonized structural neuroimaging data from 10 research centers worldwide. We analyzed brain MRI scans from 902 individuals with a primary diagnosis of schizophrenia and 952 healthy controls. RESULTS The result identified a widespread cortical thickness reduction in schizophrenia compared to their controls. Two separate meta-regression analyses revealed that a common pattern of reduced cortical gray matter thickness within the left lateral temporal lobe and right midcingulate cortex was significantly associated with both positive symptoms and aggression. CONCLUSION These findings suggested that positive symptoms such as formal thought disorder and auditory misperception, combined with cognitive impairments reflecting difficulties in deploying an adaptive control toward perceived threats, could escalate the likelihood of aggression in schizophrenia.
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Affiliation(s)
- Ting Yat Wong
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
- Department of Psychiatry, Brain and Behavioral Laboratory, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ruben C Gur
- Department of Psychiatry, Brain and Behavioral Laboratory, University of Pennsylvania, Philadelphia, PA, USA
| | - Thomas Nickl-Jockschat
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
- Department of Psychiatry, Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
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11
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Nichtová A, Volavka J, Vevera J, Příhodová K, Juríčková V, Klemsová A, Páv M, Strunzová V, Příhodová T, Nocárová M, Papoušková E, Žižka P, Kališová L. Deconstructing violence in acutely exacerbating psychotic patients. CNS Spectr 2020; 26:1-5. [PMID: 32641184 DOI: 10.1017/s1092852920001601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND This study examined the proximate causes of psychotic patients' aggression upon the admission to the psychiatric wards of a university and two state hospitals. METHODS The authors used a semistructured interview to elicit proximate causes of assaults from the assailants and victims. The treating psychiatrists and nurses provided additional information. Based on this interview, aggressive episodes were categorized as psychotic, impulsive and planned. RESULTS A total of 820 assaults committed by 289 newly admitted violent psychotic inpatients were evaluated. The interview ratings indicated that 76.71% of the assaults were directly driven by psychotic symptoms and 22.32% of all attacks were labeled as impulsive. Only 0.98% of assaults were categorized as planned. CONCLUSIONS These findings indicate that assaultive behavior among recently admitted acute psychiatric inpatients with untreated or undertreated psychosis is primarily driven by psychotic symptoms and disordered impulse control. Because each type of assault requires a different management, identifying the type of assault is crucial in determining treatment interventions.
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Affiliation(s)
- Andrea Nichtová
- Department of Psychiatry, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
- Psychiatric Hospital Bohnice, Prague, Czech Republic
| | - Jan Volavka
- Department of Psychiatry, Faculty of Medicine, University Hospital in Pilsen, Charles University, Prague, Czech Republic
| | - Jan Vevera
- Department of Psychiatry, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
- Department of Psychiatry, Faculty of Medicine, University Hospital in Pilsen, Charles University, Prague, Czech Republic
- Center for epidemiological and clinical research in Addictions, National Institute of Mental Health, Klecany, Czech Republic
- Department of Psychiatry, Institute for Postgraduate Medical Education Prague, Prague, Czech Republic
| | - Kateřina Příhodová
- Department of Psychiatry, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
- Center for epidemiological and clinical research in Addictions, National Institute of Mental Health, Klecany, Czech Republic
| | - Veronika Juríčková
- Department of Psychiatry, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
- Center for epidemiological and clinical research in Addictions, National Institute of Mental Health, Klecany, Czech Republic
| | - Anna Klemsová
- Department of Psychiatry, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Marek Páv
- Department of Psychiatry, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
- Psychiatric Hospital Bohnice, Prague, Czech Republic
| | - Věra Strunzová
- Department of Psychiatry, Institute for Postgraduate Medical Education Prague, Prague, Czech Republic
- Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | - Tereza Příhodová
- Department of Psychiatry, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
- Center for epidemiological and clinical research in Addictions, National Institute of Mental Health, Klecany, Czech Republic
- University of New York in Prague, Prague, Czech republic
| | | | | | - Petr Žižka
- Psychiatric Hospital Dobřany, Dobřany,Czech Republic
| | - Lucie Kališová
- Department of Psychiatry, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
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12
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Dexter E, Vitacco MJ. Strategies for Assessing and Preventing Inpatient Violence in Forensic Hospitals: A Call for Specificity. EUROPEAN PSYCHOLOGIST 2020. [DOI: 10.1027/1016-9040/a000393] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Abstract. Violence within inpatient forensic hospitals is a significant and enduring problem that leads to harm to staff and patients and causes significant expenditures. This paper provides comprehensive recommendations for developing and implementing violence reduction strategies within forensic settings that are predicated on appropriate evaluation for violence risk. This paper posits that proper strategies must take into account subtypes of violence and classifying risk with systematic and continuous evaluations. Treatment interventions should be geared to patients most at-risk for violence. By recognizing the dynamic nature of violence, hospital administrators can work closely with institution staff to provide support for improving the environment of forensic hospitals. By employing empirically based treatment interventions on both acute and long-term units, forensic hospitals can provide a safer environment.
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Affiliation(s)
- Erin Dexter
- Department of Psychiatry and Health Behavior, Augusta University, GA, USA
| | - Michael J. Vitacco
- Department of Psychiatry and Health Behavior, Augusta University, GA, USA
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13
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The coping process of Japanese parents who experience violence from adult children with schizophrenia. Arch Psychiatr Nurs 2018; 32:549-554. [PMID: 30029746 DOI: 10.1016/j.apnu.2018.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 03/06/2018] [Indexed: 11/21/2022]
Abstract
With the acceleration of deinstitutionalization might increase families' chances of suffering violence by patients. This study clarified parents' coping processes with violence experienced from patients with schizophrenia. The grounded theory approach was used, and 26 parents were interviewed. We identified a four-stage coping process: (1) hope for treatment, (2) living with violence, (3) trying to solve violence, and (4) last solution for violence. This coping process had two illness-related characteristics: (1) a process of coping with two main stressful events (the illness and violence), and (2) the need for long-term appraisal of violence because of its unclear causes.
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Černý M, Hodgins S, Kučíková R, Kážmér L, Lambertová A, Nawka A, Nawková L, Parzelka A, Raboch J, Bob P, Vevera J. Violence in persons with and without psychosis in the Czech Republic: risk and protective factors. Neuropsychiatr Dis Treat 2018; 14:2793-2805. [PMID: 30425497 PMCID: PMC6205133 DOI: 10.2147/ndt.s167928] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To prevent violence among persons with psychosis, further knowledge of the correlates and risk factors is needed. These risk factors may vary by nation. PATIENTS AND METHODS This study examined factors associated with violent assaults in 158 patients with psychosis and in a matched control sample of 158 adults without psychosis in the Czech Republic. Participants completed interviews and questionnaires to confirm diagnoses, report on aggressive behavior, current and past victimization, and substance use. Additional information was collected from collateral informants and clinical files. Multiple regression analyses were conducted to identify factors that were independently associated with committing an assault in past 6 months. RESULTS The presence of a psychotic disorder was associated with an increased risk of assaults (OR =3.80; 95% CI 2.060-7.014). Additional risk factors in persons with and without psychosis included recent physical victimization (OR =7.09; 95% CI 3.922-12.819), childhood maltreatment (OR =3.15; 95% CI 1.877-5.271), the level of drug use (OR =1.13; 95% CI 1.063-1.197), and the level of alcohol use (OR =1.04; 95% CI 1.000-1.084). Increasing age (OR =0.96; 95% CI 0.942-0.978) and employment (OR =0.30; 95% CI 0.166-0.540) were protective factors. Except for drug use, which appeared to have greater effect on violence in the group without psychosis, there were no major differences between patients and controls in these risk and protective factors. To our knowledge, this is the first published comparison of assault predictors between schizophrenia patients and matched controls. CONCLUSION Recent physical victimization was the strongest predictor of assaults. Our findings are consistent with the emerging empirical evidence pointing to the very important role of victimization in eliciting violent behavior by the victims. Some current prediction instruments may underestimate the risk of violent behavior as they take little account of current victimization. Although psychosis per se elevates the risk of violence, other risk and protective factors for violence in persons with psychosis and comparison group are largely similar.
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Affiliation(s)
- Martin Černý
- Department of Psychiatry, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic, .,Department of Psychiatry, Teaching Hospital Královské Vinohrady, Prague, Czech Republic
| | - Sheilagh Hodgins
- Institut Universitaire en Santé Mentale de Montréal, Département de Psychiatrie, Université de Montréal, Montréal, Quebec, Canada
| | - Radmila Kučíková
- Department of Psychiatry, Teaching Hospital Královské Vinohrady, Prague, Czech Republic.,Psychiatric Hospital Bohnice, Prague, Czech Republic
| | - Ladislav Kážmér
- Center for Epidemiological and Clinical Research in Addictions, National Institute of Mental Health, Klecany, Czech Republic
| | - Alena Lambertová
- Department of Psychiatry, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic,
| | - Alexander Nawka
- Department of Psychiatry, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic,
| | - Lucie Nawková
- Department of Psychiatry, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic,
| | - Anna Parzelka
- Department of Psychiatry, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic,
| | - Jiří Raboch
- Department of Psychiatry, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic,
| | - Petr Bob
- Department of Psychiatry, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic,
| | - Jan Vevera
- Department of Psychiatry, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic, .,7th Field Hospital, Czech Armed Forces, Hradec Králové, Czech Republic, .,Department of Psychiatry, Faculty of Medicine, University Hospital in Pilsen, Charles University, Prague, Czech Republic, .,Department of Psychiatry, Institute for Postgraduate Medical Education Prague, Prague, Czech Republic,
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15
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Ben-Zeev D, Scherer EA, Brian RM, Mistler LA, Campbell AT, Wang R. Use of Multimodal Technology to Identify Digital Correlates of Violence Among Inpatients With Serious Mental Illness: A Pilot Study. Psychiatr Serv 2017; 68:1088-1092. [PMID: 28669285 PMCID: PMC5891222 DOI: 10.1176/appi.ps.201700077] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study examined multimodal technologies to identify correlates of violence among inpatients with serious mental illness. METHODS Twenty-eight high-risk inpatients were provided with smartphones adapted for data collection. Participants recorded their thoughts and behaviors by using self-report software. Sensors embedded in each device (microphone and accelerometers) and throughout the inpatient unit (Bluetooth beacons) captured patients' activity and location. RESULTS Self-reported delusions were associated with violent ideation (odds ratio [OR]=3.08), damaging property (OR=8.24), and physical aggression (OR=12.39). Alcohol and cigarette cravings were associated with violent ideation (OR=5.20 and OR=6.08, respectively), damaging property (OR=3.71 and OR=4.26, respectively), threatening others (OR=3.62 and OR=3.04, respectively), and physical aggression (OR=6.26, and OR=8.02, respectively). Drug cravings were associated with violent ideation (OR=2.76) and damaging property (OR=5.09). Decreased variability in physical activity and noisy ward conditions were associated with violent ideation (OR=.71 and OR=2.82, respectively). CONCLUSIONS Identifiable digital correlates may serve as indicators of increased risk of violence.
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Affiliation(s)
- Dror Ben-Zeev
- Dr. Ben-Zeev and Ms. Brian are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Scherer is with the Department of Biomedical Data Science and the Department of Community and Family Medicine, and Dr. Mistler is with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire. Dr. Mistler is also with the Department of Psychiatry, New Hampshire Hospital, Concord. Dr. Campbell and Mr. Wang are with the Department of Computer Science, Dartmouth College, Hanover, New Hampshire
| | - Emily A Scherer
- Dr. Ben-Zeev and Ms. Brian are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Scherer is with the Department of Biomedical Data Science and the Department of Community and Family Medicine, and Dr. Mistler is with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire. Dr. Mistler is also with the Department of Psychiatry, New Hampshire Hospital, Concord. Dr. Campbell and Mr. Wang are with the Department of Computer Science, Dartmouth College, Hanover, New Hampshire
| | - Rachel M Brian
- Dr. Ben-Zeev and Ms. Brian are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Scherer is with the Department of Biomedical Data Science and the Department of Community and Family Medicine, and Dr. Mistler is with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire. Dr. Mistler is also with the Department of Psychiatry, New Hampshire Hospital, Concord. Dr. Campbell and Mr. Wang are with the Department of Computer Science, Dartmouth College, Hanover, New Hampshire
| | - Lisa A Mistler
- Dr. Ben-Zeev and Ms. Brian are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Scherer is with the Department of Biomedical Data Science and the Department of Community and Family Medicine, and Dr. Mistler is with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire. Dr. Mistler is also with the Department of Psychiatry, New Hampshire Hospital, Concord. Dr. Campbell and Mr. Wang are with the Department of Computer Science, Dartmouth College, Hanover, New Hampshire
| | - Andrew T Campbell
- Dr. Ben-Zeev and Ms. Brian are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Scherer is with the Department of Biomedical Data Science and the Department of Community and Family Medicine, and Dr. Mistler is with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire. Dr. Mistler is also with the Department of Psychiatry, New Hampshire Hospital, Concord. Dr. Campbell and Mr. Wang are with the Department of Computer Science, Dartmouth College, Hanover, New Hampshire
| | - Rui Wang
- Dr. Ben-Zeev and Ms. Brian are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Scherer is with the Department of Biomedical Data Science and the Department of Community and Family Medicine, and Dr. Mistler is with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire. Dr. Mistler is also with the Department of Psychiatry, New Hampshire Hospital, Concord. Dr. Campbell and Mr. Wang are with the Department of Computer Science, Dartmouth College, Hanover, New Hampshire
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16
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Measurement of agitation and aggression in adult and aged neuropsychiatric patients: review of definitions and frequently used measurement scales. CNS Spectr 2017; 22:407-414. [PMID: 28179043 DOI: 10.1017/s1092852917000050] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Agitation and aggression in adult psychiatric patients with psychoses and in persons with dementia increase the burden of disease and frequently cause hospitalization. The implementation of currently available management strategies and the development of new ones is hindered by inconsistent terminology that confuses agitation with aggression. This confusion is maintained by many rating scales that fail to distinguish between these two syndromes. We review the frequently used rating scales with a particular focus on their ability to separate agitation from aggression. Agitation and aggression are two different syndromes. For example, reactive aggression is often precipitated by rejection of care and may not be associated with agitation per se. We propose, in treatment studies of behavioral symptoms of dementia and challenging behaviors in psychoses, that outcomes should be evaluated separately for agitation and aggression. This is important for investigation of drug effectiveness since the medication may be effective against one syndrome but not the other. Separate assessments of agitation and aggression should be a general principle of trial design with particular salience for registration studies of medications proposed for approval by the U.S. Food and Drug Administration and other regulatory bodies.
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17
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Mistler LA, Ben-Zeev D, Carpenter-Song E, Brunette MF, Friedman MJ. Mobile Mindfulness Intervention on an Acute Psychiatric Unit: Feasibility and Acceptability Study. JMIR Ment Health 2017; 4:e34. [PMID: 28827214 PMCID: PMC5583505 DOI: 10.2196/mental.7717] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 05/28/2017] [Accepted: 05/29/2017] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Aggression and violence on acute psychiatric inpatient units is extensive and leads to negative sequelae for staff and patients. With increasingly acute inpatient milieus due to shorter lengths of stay, inpatient staff is limited in training and time to be able to provide treatments. Mobile technology provides a new platform for offering treatment on such units, but it has not been tested for feasibility or usability in this particular setting. OBJECTIVE The aim of this study was to examine the feasibility, usability, and acceptability of a brief mindfulness meditation mobile phone app intended to reduce anger and aggression in acute psychiatric inpatients with schizophrenia, schizoaffective disorder, or bipolar disorder, and a history of violence. METHODS Participants were recruited between November 1, 2015 and June 1, 2016. A total of 13 inpatients at an acute care state hospital carried mobile phones for 1 week and were asked to try a commercially available mindfulness app called Headspace. The participants completed a usability questionnaire and engaged in a qualitative interview upon completion of the 7 days. In addition, measures of mindfulness, state and trait anger, and cognitive ability were administered before and after the intervention. RESULTS Of the 13 enrolled participants, 10 used the app for the 7 days of the study and completed all measures. Two additional participants used the app for fewer than 7 days and completed all measures. All participants found the app to be engaging and easy to use. Most (10/12, 83%) felt comfortable using Headspace and 83% (10/12) would recommend it to others. All participants made some effort to try the app, with 6 participants (6/12, 50%) completing the first 10 10-minute "foundation" guided meditations. CONCLUSIONS This is the first known study of the use of a commercially available app as an intervention on acute psychiatric inpatient units. Acutely ill psychiatric inpatients at a state hospital found the Headspace app easy to use, were able to complete a series of meditations, and felt the app helped with anxiety, sleep, and boredom on the unit. There were no instances of an increase in psychotic symptoms reported and there were no episodes of aggression or violence noted in the record.
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Affiliation(s)
- Lisa A Mistler
- Dartmouth-Hitchcock Medical Center, Department of Psychiatry, Geisel School of Medicine at Dartmouth, Concord, NH, United States
| | - Dror Ben-Zeev
- Director, mHealth for Mental Health Program, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | | | - Mary F Brunette
- Dartmouth-Hitchcock Medical Center, Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Matthew J Friedman
- Dartmouth-Hitchcock Medical Center, Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
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18
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Association between schizophrenia and violence among Chinese female offenders. Sci Rep 2017; 7:818. [PMID: 28400569 PMCID: PMC5429758 DOI: 10.1038/s41598-017-00975-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 03/20/2017] [Indexed: 01/11/2023] Open
Abstract
Little is known about the association between schizophrenia and violence in women in China. This study aimed to examine the association between schizophrenia and violence in Chinese female offenders. Fifty-two schizophrenia patients were identified from the female offenders who received forensic psychiatric assessments in 2011 in Hunan province, China. Using a propensity score matching method, 104 matched controls without psychiatric disorders were selected from female criminals in Hunan province. Violent offences and homicides were verified and recorded. The percentages of violent offences and homicides were significantly higher in female offenders with schizophrenia than in controls (78.8% vs. 30.8%, P < 0.001; 44.2% vs. 18.3%, P = 0.001, respectively). Multivariate logistic regression analyses revealed that diagnosis of schizophrenia, younger age at first offence, living in rural area and a lower education level were independently and positively associated with violent offences, while having a diagnosis of schizophrenia and lower education level were associated with homicides. There appears to be an independent and positive association between schizophrenia and violent offence in Chinese female offenders. Effective preventive approaches on violence in female schizophrenia patients are warranted.
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19
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Quinn J, Kolla NJ. From Clozapine to Cognitive Remediation. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:94-101. [PMID: 27335156 PMCID: PMC5298523 DOI: 10.1177/0706743716656830] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Although a minority of persons with schizophrenia (SCZ) commits violent acts, SCZ remains a risk factor for violence. Here, we present a broad overview of evidence-based treatments for violence in SCZ, including biological and psychosocial interventions. METHOD We conducted MEDLINE and PsychINFO literature searches to retrieve articles relating to treatments for violent, hostile, or aggressive behaviours in SCZ. RESULTS Clozapine shows the strongest evidence for treating the acute violence of SCZ. Other atypical antipsychotics also possess antiaggressive effects, although the evidence is not as robust as that for clozapine. Psychosocial treatments can be useful adjuncts to pharmacotherapy once patients' positive symptoms have stabilized. Cognitive behavioural therapy for psychosis and cognitive remediation are 2 psychosocial interventions that have demonstrated positive outcomes for violence in SCZ. Most psychosocial studies that examined violence as an outcome were conducted in forensic psychiatric settings. CONCLUSIONS Effective treatments exist for persons with SCZ who pose a risk for violent and aggressive behaviour, although the overall evidence base remains relatively weak. More randomized controlled trials of programs showing evidence for reduction of violence in SCZ are required. Further research should delineate which patients could benefit from multimodal treatment and where and when such treatments are optimally delivered.
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Affiliation(s)
- Jason Quinn
- 1 Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Nathan J Kolla
- 2 Complex Mental Illness Program, Forensic Service, Violence Prevention Neurobiological Research Unit, Centre for Addiction and Mental Health, Toronto, Ontario.,3 Institute of Medical Science, University of Toronto, Toronto, Ontario.,4 Centre for Criminology and Sociolegal Studies, University of Toronto, Toronto, Ontario
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20
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Knezevic V, Mitrovic D, Drezgic-Vukic S, Knezevic J, Ivezic A, Siladji-Mladenovic D, Golubovic B. Prevalence and Correlates of Aggression and Hostility in Hospitalized Schizophrenic Patients. JOURNAL OF INTERPERSONAL VIOLENCE 2017; 32:151-163. [PMID: 26037811 DOI: 10.1177/0886260515585537] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This study is aimed at identifying the incidence as well as clinical and socio-demographic correlates of aggression in hospitalized schizophrenic patients. We prospectively recruited participants with Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.) diagnosis of schizophrenia presenting to the Clinic for Psychiatry during a 2-year period. We used the Modified Overt Aggression Scale to assess the aggression and Positive and Negative Syndrome Scale (PANSS) to assess the clinical characteristics of participants. One out of three patients with schizophrenia (31%) was aggressive and hostile at the time of presentation. Socio-demographic variables (such as gender, age, duration of illness, and number of hospitalizations) were poor predictors of aggression for schizophrenic patients. The level of aggression was not associated with the clinical characteristics in aggressive and hostile hospitalized schizophrenic patients. However, there was a weak negative association between the level of aggression and the PANSS Negative Scale ( p < .01). In conclusion, socio-demographic variables and clinical characteristics seem to be not such good predictors of aggressive behavior in hospitalized schizophrenic patients. Nevertheless, the results of our study contribute to the understanding of the prediction and treatment of aggression in a well-defined cohort of schizophrenic patients.
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21
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Meyer JM, Cummings MA, Proctor G, Stahl SM. Psychopharmacology of Persistent Violence and Aggression. Psychiatr Clin North Am 2016; 39:541-556. [PMID: 27836150 DOI: 10.1016/j.psc.2016.07.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Persistent violence not due to acute psychosis or mania can be managed only after appropriate characterization of the aggressive episodes (psychotic, impulsive, or predatory/planned/instrumental). The type of violence combined with the psychiatric diagnosis dictates the evidence-based pharmacologic approaches for psychotically motivated and impulsive aggression, whereas instrumental violence mandates forensic/behavioral strategies. For nonacute inpatients, schizophrenia spectrum disorders, traumatic brain injury, and dementia comprise the majority of individuals who are persistently aggressive, with impulsive actions the most common form of violence across all diagnoses. Neurobiological considerations combined with empirical data provide a comprehensive framework for systematic medication trials to manage persistently aggressive patients.
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Affiliation(s)
- Jonathan M Meyer
- California Department of State Hospitals (DSH), Psychopharmacology Resource Network, DSH-Patton, 3102 East Highland Avenue, Patton, CA 92369, USA; Department of Psychiatry, University of California, San Diego; 9500 Gilman Drive, MC 0603, La Jolla, CA 92093-0603, USA.
| | - Michael A Cummings
- California Department of State Hospitals (DSH), Psychopharmacology Resource Network, DSH-Patton, 3102 East Highland Avenue, Patton, CA 92369, USA
| | - George Proctor
- California Department of State Hospitals (DSH), Psychopharmacology Resource Network, DSH-Patton, 3102 East Highland Avenue, Patton, CA 92369, USA
| | - Stephen M Stahl
- Department of Psychiatry, University of California, San Diego; 9500 Gilman Drive, MC 0603, La Jolla, CA 92093-0603, USA; California Department of State Hospitals (DSH), Bateson Building, 1600 9th Street, Room 400, Sacramento, CA 95814, USA
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22
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Abstract
Inpatient violence constitutes a major concern for staff, patients, and administrators. Violence can cause physical injury and psychological trauma. Although violence presents a challenge to inpatient clinicians, it should not be viewed as inevitable. By looking at history of violence, in addition to clinical and other historical factors, clinicians can identify which patients present the most risk of exhibiting violent behavior and whether the violence would most likely flow from psychosis, impulsivity, or predatory characteristics. With that information, clinicians can provide environmental and treatment modifications to lessen the likelihood of violence.
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Selenius H, Leppänen Östman S, Strand S. Self-harm as a risk factor for inpatient aggression among women admitted to forensic psychiatric care. Nord J Psychiatry 2016; 70:554-60. [PMID: 27224513 DOI: 10.1080/08039488.2016.1183707] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Inpatient aggression among female forensic psychiatric patients has been shown to be associated with self-harm, that is considered to be a historical risk factor for violence. Research on associations between previous or current self-harm and different types of inpatient aggression is missing. AIM The aim of this register study was to investigate the prevalence of self-harm and the type of inpatient aggression among female forensic psychiatric inpatients, and to study whether the patients' self-harm before and/or during forensic psychiatric care is a risk factor for inpatient aggression. METHODS Female forensic psychiatric patients (n = 130) from a high security hospital were included. RESULTS The results showed that 88% of the female patients had self-harmed at least once during their life and 57% had been physically and/or verbally aggressive towards staff or other patients while in care at the hospital. Self-harm before admission to the current forensic psychiatric care or repeated self-harm were not significantly associated with inpatient aggression, whereas self-harm during care was significantly associated with physical and verbal aggression directed at staff. CONCLUSIONS These results pointed towards self-harm being a dynamic risk factor rather than a historical risk factor for inpatient aggression among female forensic psychiatric patients. Whether self-harm is an individual risk factor or a part of the clinical risk factor 'Symptom of major mental illness' within the HCR-20V3 must be further explored among women. Thus, addressing self-harm committed by female patients during forensic psychiatric care seems to be important in risk assessments and the management of violence, especially in reducing violence against staff in high-security forensic psychiatric services.
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Affiliation(s)
- Heidi Selenius
- a School of Law, Psychology and Social Work, Örebro University , Sweden
| | | | - Susanne Strand
- a School of Law, Psychology and Social Work, Örebro University , Sweden ;,c Centre for Forensic Behavioural Science at Swinburne University of Technology , Melbourne , Australia
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Hoptman MJ, Ahmed AO. Neural Foundations of Mood-Induced Impulsivity and Impulsive Aggression in Schizophrenia. Curr Behav Neurosci Rep 2016. [DOI: 10.1007/s40473-016-0081-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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25
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Karabekiroğlu A, Pazvantoğlu O, Karabekiroğlu K, Böke Ö, Korkmaz IZ. Associations with violent and homicidal behaviour among men with schizophrenia. Nord J Psychiatry 2016; 70:303-8. [PMID: 26634311 DOI: 10.3109/08039488.2015.1109139] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective We aimed to assess the risk factors associated with homicidal behaviour in male patients diagnosed with schizophrenia. Methods In a period of 1 year, male schizophrenia cases between 18-65 years of age (n = 210) were included. The clinical evaluation included the Positive and Negative Syndrome Scale (PANSS) and Overt Aggression Scale (OAS). The patients were divided into three groups in terms of violent behaviour history: (1) homicide group (n = 30), (2) a violent act resulting in serious injury (n = 71), (3) control group (patients without a history of a violent act) (n = 109). Results Lower level of education, rural residence, being unemployed and living alone were found to be significantly more common in patients who had committed a violent act compared to the schizophrenia patients in the control group. In order to explore the predictive value of several factors associated with violent behaviour, a logistic regression model was used, and variables (shorter duration of education, living alone, and lack of insight) significantly predicted the presence of violent behaviour (murder and/or injury) (χ(2)=31.78, df = 12, p = 0.001). Conclusions In order to be able to determine causality of homicidal acts in schizophrenia patients, our significant findings between homicidal violence, non-homicidal violence and the control group would merit further attention and exploration in further studies.
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Affiliation(s)
- Aytül Karabekiroğlu
- a Department of Psychiatry , Training and Research Hospital , Samsun , Turkey
| | | | - Koray Karabekiroğlu
- c Department of Child and Adolescent Psychiatry , Ondokuz Mayis University Medical Faculty , Samsun , Turkey
| | - Ömer Böke
- d Department of Psychiatry , Ondokuz Mayis University Medical Faculty , Samsun , Turkey
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Psychiatrie en milieu pénitentiaire : une sémiologie à part ? ANNALES MEDICO-PSYCHOLOGIQUES 2015. [DOI: 10.1016/j.amp.2015.07.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
This paper examined predictors of length of stay in a freestanding geriatric psychiatry hospital. Data on patient and treatment characteristics of geriatric inpatients (N = 1,593) were extracted from an archival administrative tracking database from Mary Starke Geriatric Harper Center. Five independent variables (length of time between last discharge and most recent admission, number of previous admissions, number of assaults, co-morbid medical condition, and admitting psychiatric diagnosis) were entered into a hierarchical regression model as potential predictors of length of stay in a geriatric psychiatry hospital. Number of assaults committed by the patient was the only significant predictor of length of stay, such that patients that had a greater number of assaults were more likely to have longer lengths of stay than those with fewer assaults. These findings highlight the importance of identifying patients at risk for assaultive behavior and developing effective interventions for aggression in geriatric psychiatry hospitals.
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Abstract
The relationship between mental illness, violence, and criminal behavior is complex, and involves a multifaceted interaction of biological, psychological, and social processes. In this article, we review the emerging research that examines the neurobiological and psychological factors that distinguish between persons with mental illness who do and who do not engage in crime and violence. Additionally, a novel model for understanding the interaction between mental illness and criminalness is proposed. (As defined by Morgan and colleagues, criminalness is defined as behavior that breaks laws and social conventions and/or violates the rights and wellbeing of others.) Stemming from this model and outlined research, we argue that management and treatment approaches should target the co-occurring domains of mental illness and criminalness to improve criminal and psychiatric outcomes. Specifically, we discuss and propose effective housing (management) and biopsychosocial intervention strategies for improving outcomes.
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Abstract
Almost no literature addresses treatment planning for the forensic psychiatric patient. In the absence of such guidance, recovery-oriented multifocal treatment planning has been imported into forensic mental health systems from community psychiatric settings, despite the fact that conditions of admission and discharge are vastly different for forensic psychiatry inpatients. We propose that instead of focusing on recovery, forensic treatment planning should prioritize forensic outcomes, such as restoration of trial competence or mitigation of violence risk, as the first steps in a continuum of care that eventually leads to the patient's ability to resolve forensic issues and return to the community for recovery-oriented care. Here we offer a model for treatment planning in the forensic setting.
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Abstract
Impulsive violence may be the behavioral consequence of inefficient information processing within specific neuronal networks. Analogous to the hypothetical pathophysiology of addiction, maladaptations within reward pathways may shift goal-directed behaviors to impulsive reactions and then to compulsive habits, in order to create impulsive violence.
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Abstract
Many forensic psychiatric settings serve unique populations who have, in addition to traditional psychiatric symptoms, diverse legal and criminogenic needs. A lack of clear treatment standards that address all aspects of forensic care can lead to inefficient or inappropriate interventions and contribute to institutional violence.
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Abstract
Elevations of impulsive behavior have been observed in a number of serious mental illnesses. These phenomena can lead to harmful behaviors, including violence, and thus represent a serious public health concern. Such violence is often a reason for psychiatric hospitalization, and it often leads to prolonged hospital stays, suffering by patients and their victims, and increased stigmatization. Despite the attention paid to violence, little is understood about its neural basis in schizophrenia. On a psychological level, aggression in schizophrenia has been primarily attributed to psychotic symptoms, desires for instrumental gain, or impulsive responses to perceived personal slights. Often, multiple attributions can coexist during a single aggressive incident. In this review, I discuss the neural circuitry associated with impulsivity and aggression in schizophrenia, with an emphasis on implications for treatment. Impulsivity appears to account for a great deal of aggression in schizophrenia, especially in inpatient settings. Urgency, defined as impulsivity in the context of strong emotion, is the primary focus of this article. It is elevated in several psychiatric disorders, and in schizophrenia, it has been related to aggression. Many studies have implicated dysfunctional frontotemporal circuitry in impulsivity and aggression in schizophrenia, and pharmacological treatments may act via that circuitry to reduce urgency and aggressive behaviors; however, more mechanistic studies are critically needed. Recent studies point toward manipulable neurobehavioral targets and suggest that cognitive, pharmacological, neuromodulatory, and neurofeedback treatment approaches can be developed to ameliorate urgency and aggression in schizophrenia. It is hoped that these approaches will improve treatment efficacy.
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Affiliation(s)
- Matthew J. Hoptman
- Research Scientist, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY
- Research Associate Professor, Department of Psychiatry, New York University School of Medicine, New York, NY
- Adjunct Associate Professor, Department of Psychology, City University of New York, New York, NY
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Illustrative cases to support the Cal-VAT guidelines. CNS Spectr 2015; 20:311-8. [PMID: 25817927 DOI: 10.1017/s1092852915000127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
There is increasing interest in developing more nuanced methods for managing aggression and violence in long-term psychiatric inpatient settings. However, the dearth of controlled studies has, at times, hampered presentation of viable options. Following the publication of guidelines developed in the California State Hospital forensic system, the authors present a group of 7 cases illustrating different approaches to violence management, including pharmacological, psychotherapeutic, and environmental interventions.
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Kelly EL, Subica AM, Fulginiti A, Brekke JS, Novaco RW. A cross-sectional survey of factors related to inpatient assault of staff in a forensic psychiatric hospital. J Adv Nurs 2014; 71:1110-22. [DOI: 10.1111/jan.12609] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Erin L. Kelly
- Health Services Research Center; University of California, Los Angeles; California USA
| | - Andrew M. Subica
- Psychology Applied Research Center; Loyola Marymount University; Los Angeles California USA
| | - Anthony Fulginiti
- School of Social Work; University of Southern California; Los Angeles California USA
| | - John S. Brekke
- School of Social Work; University of Southern California; Los Angeles California USA
| | - Raymond W. Novaco
- School of Social Ecology; University of California; Irvine California USA
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Imai A, Hayashi N, Shiina A, Sakikawa N, Igarashi Y. Factors associated with violence among Japanese patients with schizophrenia prior to psychiatric emergency hospitalization: a case-controlled study. Schizophr Res 2014; 160:27-32. [PMID: 25458570 DOI: 10.1016/j.schres.2014.10.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 09/09/2014] [Accepted: 10/07/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Numerous studies have examined a wide range of risk factors associated with violence among patients with schizophrenia. However, risk factors linked to different socio-cultural backgrounds remain unclear. OBJECTIVE The objectives were to investigate factors associated with violence among Japanese patients with schizophrenia prior to emergency hospitalizations and to compare them with factors found in studies on other populations. METHODS We recruited 420 Japanese patients with schizophrenia who had committed violent acts immediately prior to emergency admission to a psychiatric hospital in Tokyo, during the period 1986 to 2005. Cases were compared with controls (non violent hospitalized patients with schizophrenia) matched for gender, age and admission year. All medical records were reviewed retrospectively. Inter-rater reliability tests of assessment were performed. Conditional logistic regression analysis was used to identify factors associated with violence. RESULTS The symptoms of gross excitement, prior violence, auditory hallucinations, systematization of delusions, incoherence of speech, delusions of reference, TCO symptoms, living with others and long duration of illness were found to be associated with violence. In contrast, antisocial traits such as substance abuse and antisocial episodes were not recognized as significant violence-associated factors. CONCLUSION Violence among Japanese patients with schizophrenia was strongly associated with elements of schizophrenia itself, rather than antisocial traits. This study highlighted associated factors for violence among Japanese patients with schizophrenia which differ distinctly from associated factors in other countries. This result demonstrates that future studies assessing the risk of violence among patients with schizophrenia need to consider cultural and racial differences in cohorts.
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Affiliation(s)
- Atsushi Imai
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan; Division of Law and Psychiatry, Center for Forensic Mental Health, Chiba University, Chiba, Japan.
| | - Naoki Hayashi
- Department of Psychiatry, Teikyo University School of Medicine, Tokyo Japan
| | - Akihiro Shiina
- Department of Psychiatry, Chiba University Hospital, Chiba, Japan
| | - Noriko Sakikawa
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Yoshito Igarashi
- Division of Law and Psychiatry, Center for Forensic Mental Health, Chiba University, Chiba, Japan
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Jones N, Shattell M. Beyond easy answers: facing the entanglements of violence and psychosis. Issues Ment Health Nurs 2014; 35:809-11. [PMID: 25259645 DOI: 10.3109/01612840.2013.856971] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Nev Jones
- DePaul University, Department of Psychology, Chicago, Illinois, USA
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Treating the violent patient with psychosis or impulsivity utilizing antipsychotic polypharmacy and high-dose monotherapy. CNS Spectr 2014; 19:439-48. [PMID: 25119976 DOI: 10.1017/s1092852914000388] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Insufficient treatment of psychosis often manifests as violent and aggressive behaviors that are dangerous to the patient and others, and that warrant treatment strategies which are not considered first-line, evidence-based practices. Such treatment strategies include both antipsychotic polypharmacy (simultaneous use of 2 antipsychotics) and high-dose antipsychotic monotherapy. Here we discuss the hypothesized neurobiological substrates of various types of violence and aggression, as well as providing arguments for the use of antipsychotic polypharmacy and high-dose monotherapy to target dysfunctional neurocircuitry in the subpopulation of patients that is treatment-resistant, violent, and aggressive. In this review, we focus primarily on the data supporting the use of second-generation, atypical antipsychotics both at high doses and in combination with other antipsychotics.
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Deconstructing violence as a medical syndrome: mapping psychotic, impulsive, and predatory subtypes to malfunctioning brain circuits. CNS Spectr 2014; 19:357-65. [PMID: 25296964 DOI: 10.1017/s1092852914000522] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Violence is a major management issue for forensic mental health systems. Violence can be approached as a medical syndrome and deconstructed into psychotic, impulsive, and predatory subtypes, which are hypothetically mapped onto corresponding malfunctioning brain circuits. Rational management of violence balances treatment with security, while targeting each subtype of violence with approaches unique to the psychotic, impulsive, and predatory forms of violence.
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The new mission of forensic mental health systems: managing violence as a medical syndrome in an environment that balances treatment and safety. CNS Spectr 2014; 19:368-73. [PMID: 25032946 DOI: 10.1017/s109285291400025x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The association between violence and mental illness is well-studied, yet remains highly controversial. Currently, there appears to be a trend of increasing violence in state hospital settings, including both civilly and forensically committed populations. In fact, physical aggression is the primary reason for admission to many state hospitals. Given that violence is now often both a reason for admission and a barrier to discharge, there is a case to be made for psychiatric violence to be re-conceptualized dimensionally, as a primary syndrome, not as the byproduct of one. Furthermore, treatment settings need to be enhanced to address the new types of violence exhibited in inpatient environments, and this modification needs to be geared toward balancing safety with treatment.
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40
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Abstract
The threat of violence is a major concern for all individuals working or receiving treatment in an inpatient psychiatric setting. One major focus in forensic psychology and psychiatry over the past several decades has been the development of risk assessments to aid in the identification of those individuals most at risk of exhibiting violent behavior. So-called second- and third-generation risk assessments were developed to improve the accuracy of decision making. While these instruments were developed for use in the community, many have proven to be effective in identifying patients more likely to exhibit institutional aggression. Because the purpose of risk assessment is the reduction of violence, dynamic factors were included in third-generation risk instruments to provide opportunities for intervention and methods for measuring change. Research with these instruments indicates that both static factors (second-generation) and dynamic factors (third-generation) are important in identifying those patients most likely to engage in institutional aggression, especially when the aggression is categorized by type (impulsive/reactive, organized/predatory/instrumental, psychotic). Recent research has indicated that developing a typology of aggressive incidents may provide insight both into precipitants to assaults as well as appropriate interventions to reduce such aggression. The extant literature suggests that both static and dynamic risk factors are important, but may be differentially related to the type of aggression exhibited and the characteristics of the individuals exhibiting the aggression.
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Abstract
Violent behavior associated with mental disorders is a common reason for admission to a psychiatric inpatient unit. Once hospitalized, patients may continue to be intermittently agitated and have persistent aggressive behaviors, preventing their discharge back into the community. Managing agitation quickly with effective pharmacological agents can avoid further escalation to aggression and violence. In the acute setting, this usually involves the parenteral use of antipsychotics, with or without benzodiazepines. Within the past decade, short-acting intramuscular formulations of second-generation antipsychotics have become available and provide a means to induce calm with a substantially lower risk of acute dystonia or akathisia compared with haloperidol. New alternative formulations that avoid injections include inhalation and sublingual administration. Longer-term management of persistent aggressive behavior by reducing the frequency and intensity of future episodes of agitation is more complex. In contrast to agitation associated with schizophrenia or bipolar mania, no agents have yet been approved by regulatory agencies for the treatment of persistent aggressive behavior. The strongest evidence supports the use of clozapine as an antihostility agent, followed by olanzapine. Adjunctive strategies with anticonvulsants and beta-adrenergic agents may also be worthwhile to consider.
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Abstract
Previous reviews of the literature from 1976 to 2000 documented two categories of assaultive psychiatric patients: (1) male patients with schizophrenic illness and histories of violence toward others and substance use disorder and (2) male/female patients with personality disorders and histories of violence toward others, personal victimization, and substance use. The present study reviewed the published findings on American assaultive patients from 2000 to 2012. The present findings partially supported the earlier findings in that patients with schizophrenic illness continued to present the greatest risk for assault. However, personality disordered patients were not equal in assault risk to patients with affective disorders. Possible explanations for these findings and a detailed methodological review are presented.
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43
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Abstract
BACKGROUND Difficulties with affect regulation and impulse control have a strong influence on violence. The objective of this study was to determine whether baseline depression and impulsivity predict aggression and whether they predict differential response to antiaggressive treatment. This is important, as we lack knowledge as to the selection of antipsychotics for the treatment of aggression. METHODS Physically aggressive inpatients with schizophrenia who received an evaluation of depression and impulsivity at baseline were randomly assigned in a double-blind, parallel group, 12-week trial to clozapine, olanzapine, or haloperidol. Trait impulsivity was measured by the Barratt Impulsiveness Scale; depression by the Positive and Negative Syndrome Scale Depression factor. The number and severity of aggressive events, as measured by the Modified Overt Aggression Scale (MOAS), were the outcome measures. RESULTS Baseline depression and impulsivity predicted higher levels of aggression, as measured by the MOAS total score, over the 12-week treatment period across all 3 medication groups. In addition, there was a strong interaction effect between baseline depression/impulsivity and medication grouping in predicting MOAS score. In particular, when higher depression and impulsivity were present at baseline, patients on haloperidol presented with more aggression than patients on the other 3 medications. CONCLUSIONS Depression and impulsivity are important predictors of aggression and of differential response to antiaggressive treatment. This is most likely due to the medications' dissimilar neurotransmitter profiles. By identifying patients who will respond better to a given medication, we will be able to develop individualized strategies for the treatment of violent behavior.
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Affiliation(s)
- Menahem I Krakowski
- The Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY; Department of Psychiatry, New York University School of Medicine, New York, NY;
| | - Pal Czobor
- The Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY; Departments of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
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Urheim R, Rypdal K, Melkevik O, Hoff HA, Mykletun A, Palmstierna T. Motivational dimensions of inpatient aggression. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2014; 24:141-150. [PMID: 24677684 DOI: 10.1002/cbm.1894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 05/29/2013] [Accepted: 10/08/2013] [Indexed: 06/03/2023]
Abstract
BACKGROUND Recent studies have suggested that functional classifications of aggression should be used to improve the understanding of the heterogeneity of aggression and its management, among inpatients in psychiatric hospitals. AIMS Our aim was to examine a theoretically derived three-factor model for conceptualising aggressive incidents by inpatients as irritable, instrumental or defensive. METHODS As part of the routine assessments in a forensic psychiatric high security ward, staff filled out a questionnaire on motives for aggression after all violent incidents. A total of 1652 incidents from 28 patients were analysed by means of exploratory and confirmatory factor analyses. RESULTS Support was found for the three-factor model. For the most part, the scale items loaded on the factors as predicted, and the model was able to explain 61% of the data variance. Irritable incidents were the most common, but elevated scores for instrumental characteristics were found as well. High psychopathy scores were associated with incidents scoring high values on both irritable and instrumental dimensions, and low values on the defensive dimensions. CONCLUSIONS Confirming these three dimensions of inpatient aggressive incidents may help caregivers' understanding of aggressive behaviour. If confirmed in future studies, this dimensional approach may prove useful for the management of aggressive inpatients.
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Affiliation(s)
- Ragnar Urheim
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
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Abstract
Schizophrenia without any comorbidity confers a modest, but statistically significant elevation of the risk for violence. That risk is considerably increased by comorbid antisocial personality disorder or psychopathy as well as by comorbid substance use disorders. These comorbidities are frequent. Conduct disorder and conduct disorder symptoms elevate the risk for aggressive behavior in patients with schizophrenia. Violence among adults with schizophrenia may follow at least two distinct pathways-one associated with premorbid conditions, including antisocial conduct, and another associated with the acute psychopathology of schizophrenia. Aggressive behavior in bipolar disorder occurs mainly during manic episodes, but it remains elevated in euthymic patients in comparison with controls. The risk of violent behavior is increased by comorbidity with borderline personality disorder, antisocial personality disorder, and substance use disorders. These comorbidities are frequent. Borderline personality disorder and bipolar disorder are related in their phenomenology and response to medication. These two disorders share a tendency to impulsiveness, and impulsive behavior, including impulsive aggression, is particularly expressed when they co-occur.
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Affiliation(s)
- Jan Volavka
- Emeritus of Psychiatry, New York University School of Medicine, PO Box 160663, Big Sky, MT, 59716, USA,
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46
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Abstract
Most individuals diagnosed with a mental illness are not violent, but some mentally ill patients commit violent acts. PubMed database was searched for articles published between 1980 and November 2013 using the combination of key words “schizophrenia” or “bipolar disorder” with “aggression” or “violence.” In comparison with the general population, there is approximately a twofold increase of risk of violence in schizophrenia without substance abuse comorbidity and ninefold with such comorbidity. The risk in bipolar disorder is at least as high as in schizophrenia. Most of the violence in bipolar disorder occurs during the manic phase. Violence among adults with schizophrenia may follow two distinct pathways: one associated with antisocial conduct and another associated with the acute psychopathology, particularly anger and delusions. Clozapine is the most effective treatment of aggressive behavior in schizophrenia. Emerging evidence suggests that olanzapine may be the second most effective treatment. Treatment nonadherence greatly increases the risk of violent behavior, and poor insight as well as hostility is associated with nonadherence. Nonpharmacological methods of treatment of aggression in schizophrenia and bipolar disorder are increasingly important. Cognitive behavioral approaches appear to be effective in cases where pharmacotherapy alone is not sufficient.
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Hodgins S, Piatosa MJ, Schiffer B. Violence among people with schizophrenia: phenotypes and neurobiology. Curr Top Behav Neurosci 2014; 17:329-68. [PMID: 24318935 DOI: 10.1007/7854_2013_259] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
People with schizophrenia are at increased risk, as compared to the general population, to acquire convictions for violent crimes and homicide. They also show elevated levels of aggressive behaviour. While psychotic symptoms explain aggressive behaviour that is common during acute episodes, they do not explain such behaviour at other stages of illness or prior to illness onset. Three distinct phenotypes have been identified: individuals with a childhood onset of conduct disorder who display antisocial and aggressive behaviour both before and after schizophrenia onset; individuals with no history of conduct problems who begin engaging in aggressive behaviour as illness onsets; and individuals who after many years of illness engage in a severe physical assault. Little is known about the aetiology of the three types of offenders and about the neural mechanisms that initiate and maintain these behaviours. We hypothesize that schizophrenia preceded by conduct disorder is associated with a combination of genes conferring vulnerability for both disorders and altering the effects of environmental factors on the brain, and thereby, with a distinct pattern of neural development. Some evidence is available to support this hypothesis. By contrast, offending among adults with schizophrenia who have no history of such behaviour prior to illness may result from the changes in the brain that occur as illness onsets, and that are further altered by comorbid conditions such as substance misuse, or by the progressive changes in the brain through adulthood that may result from the illness and from the use of antipsychotic medications.
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Affiliation(s)
- Sheilagh Hodgins
- Département de Psychiatrie, Université de Montréal, Montréal, Canada,
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Carabellese F, Rocca G, Candelli C, Catanesi R. Mental illness, violence and delusional misidentifications: The role of Capgras' syndrome in matricide. J Forensic Leg Med 2014; 21:9-13. [DOI: 10.1016/j.jflm.2013.10.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 10/01/2013] [Accepted: 10/27/2013] [Indexed: 11/29/2022]
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Citrome L. Addressing the need for rapid treatment of agitation in schizophrenia and bipolar disorder: focus on inhaled loxapine as an alternative to injectable agents. Ther Clin Risk Manag 2013; 9:235-45. [PMID: 23723707 PMCID: PMC3665578 DOI: 10.2147/tcrm.s31484] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Agitation (excessive motor or verbal activity) can be associated with schizophrenia or bipolar mania, and can further escalate into aggressive behavior and potentially lead to injuries in patients and staff. Medications used to treat agitation include antipsychotics and benzodiazepines, usually administered intramuscularly when rapid action is desired. Loxapine, a first-generation antipsychotic, has recently been reformulated into an inhaled powder that allows for direct administration to the lungs, resulting in rapid absorption into the systemic circulation. Administered via a single-use device, inhaled loxapine was tested in randomized controlled trials in agitation associated with schizophrenia or bipolar mania; doses of 5 mg and 10 mg were found to be efficacious, with an apparent dose response. In the Phase III studies, number needed to treat versus placebo for a ≥40% reduction from baseline on the Positive and Negative Syndrome Scale – Excited Component (PANSS-EC) at 2 hours was three for patients with bipolar disorder, and five for 5 mg and four for 10 mg for patients with schizophrenia, with effect sizes comparable to what has been observed in analogous studies of intramuscular injection of antipsychotics or lorazepam. Separation from placebo on the PANSS-EC was as early as 10 minutes postinhalation, the first time point where this was measured. Dysgeusia was the most commonly encountered spontaneously reported adverse event. Adverse events related to extrapyramidal symptoms and akathisia were relatively rare. Spirometry studies identified the potential for bronchospasm particularly in persons with asthma. Because of concerns over pulmonary safety, inhaled loxapine is restricted to use in hospitals and patients need to be prescreened for the presence of pulmonary disease, as well as monitored for signs and symptoms of bronchospasm for 1 hour postdose administration, as per a Food and Drug Administration-mandated Risk Evaluation and Mitigation Strategy.
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Affiliation(s)
- Leslie Citrome
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, NY, USA
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50
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Bo S, Forth A, Kongerslev M, Haahr UH, Pedersen L, Simonsen E. Subtypes of aggression in patients with schizophrenia: the role of personality disorders. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2013; 23:124-137. [PMID: 23595863 DOI: 10.1002/cbm.1858] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Revised: 08/01/2012] [Accepted: 01/29/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Research has repeatedly demonstrated that schizophrenia has a small but significant association with violence. It is further recognised that a subgroup of people with such links also have personality disorders, but the extent to which type of violence or aggression varies according to subgroup is less clear. AIM This study aimed to investigate, among co-morbid cases, if the number or type of personality disorders predicts type of aggression. METHODS In a cross-sectional study, 108 patients with schizophrenia were assessed for personality disorder, Axis-I diagnosis, verbal IQ, social functioning and type of aggression. RESULTS Logistic regression revealed that the more personality disorders identified (Cluster B personality disorders compared with Clusters A and C) and anti-social personality disorder compared with other Cluster B disorders significantly predicted premeditated aggression. CONCLUSIONS These findings suggest that detailed personality assessment should be a routine part of comprehensive assessment of patients with schizophrenia. Improved knowledge of the presence and type of personality disorders may help detect and manage the risk of some types of aggression.
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Affiliation(s)
- Sune Bo
- Department of Forensic Psychiatry, Region Zealand, Slagelse, Denmark.
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