The relationship between history of violent and criminal behavior and recognition of facial expression of emotions in men with schizophrenia and schizoaffective disorder

Parental Phubbing and Children's Social Withdrawal and Aggression: A Moderated Mediation Model of Parenting Behaviors and Parents' Gender

The present study sought to examine whether parental phubbing was significantly related to children's social withdrawal and aggression, and determine whether positive and negative parenting behaviors mediated this association. We further examined whether parents' gender moderated the direct and indirect relationships between parental phubbing and children's social withdrawal and aggression. The participants included 465 Chinese fathers and mothers from different families, and each father or mother had one child from preschool and early school aged 4-10 years. They completed the measures regarding their experience with parental phubbing, positive and negative parenting behaviors, and children's social withdrawal and aggression. Results showed that parental phubbing was positively related to children's social withdrawal and aggression. Positive and negative parenting behaviors significantly mediated the associations between parental phubbing and children's social withdrawal and aggression. Furthermore, parents' gender moderated the relationships between parental phubbing and children's social withdrawal and aggression. Specifically, in the mediating model of positive parenting behavior, the pathways from parental phubbing to children's social withdrawal and parental phubbing to children's aggression were significantly different. In the mediating model of negative behavior, the pathway from negative parenting behavior to children's social withdrawal was significantly different.

Mistakes in interpersonal perceptions: Social cognition in aggressive forensic psychiatry patients

BACKGROUND

While there is an established link between untreated psychosis and aggression, an enhanced understanding of the role of social cognition is still needed.

AIMS

To examine social cognitive functioning among patients in a specialist forensic mental health service who had been deemed not criminally responsible for acts of violence due to a psychotic disorder. It was hypothesised, first, that such patients would show reduced social cognitive functioning compared with healthy, nonviolent comparison participants and, second, that those who continued to be aggressive while inpatients would demonstrate significant reductions compared to the now nonaggressive group.

METHODS

The study samples were of 10 recently aggressive and 15 not-recently aggressive patients and 20 healthy, nonviolent comparison participants. Each completed the Toronto Empathy Questionnaire (TEQ), the Reading the Mind in the Eyes Test-Revised (RMET) and the Interpersonal Perception Task-15 (IPT-15).

RESULTS

There was no significance between group differences on the RMET and TEQ. The patient group as a whole, however, showed significant interpersonal misperceptions, with specific misperceptions on IPT-15 deception and kinship subscales, while at the same time lacking self-awareness of their errors. Misperceptions on the IPT-15 competition subscale were unique to recently aggressive patients.

CONCLUSIONS

Select aspects of reduced social cognitive functioning were found among not criminally responsible patients with psychosis who had committed violent acts and who continued to act aggressively while forensic inpatients. These findings enhance our understanding of the role of social cognition in predisposing toward violence and the potential importance of incorporating interventions which improve social cognition directly. We suggest also the potential for future research using virtual reality technologies in treatment.

The Impact of Sexual Arousal and Emotion Regulation on Men's Sexual Aggression Proclivity

Extant literature supports a relationship between sexual arousal and increased likelihood of sexually coercive behavior in men. The present study investigated the impact of sexual arousal on sexual coercion proclivity and the degree to which emotion regulation moderated this relationship in the context of two separate affect inductions. We predicted that sexual arousal would more strongly predict sexual coercion likelihood for men scoring lower on emotion regulation ability compared with men with above average emotion regulation abilities. Male participants with (n = 38) and without (n = 40) self-reported histories of sexual coercion were recruited from urban sexually transmitted infection testing clinics. Participants completed a measure of emotion regulation, underwent a positive and negative affect induction, viewed an erotic video, and reported on their level of sexual arousal immediately prior to completing a hypothetical sexual coercion likelihood laboratory task. Relationships between emotion regulation, sexual arousal, and sexual coercion likelihood were examined using moderation analyses. Sexual arousal was associated with greater reported sexual coercion likelihood. For men with poorer emotion regulation, sexual arousal significantly and positively predicted sexual coercion likelihood in the positive affect condition. Sexual arousal did not significantly predict sexual coercion for men with above average emotion regulation. Findings may have implications for the assessment of individual risk for coercive sexual behavior as well as primary prevention efforts.

Processing of Spoken Emotions in Schizophrenia: Forensic and Non-forensic Patients Differ in Emotional Identification and Integration but Not in Selective Attention

Patients with schizophrenia (PwS) typically demonstrate deficits in visual processing of emotions. Less is known about auditory processing of spoken-emotions, as conveyed by the prosodic (tone) and semantics (words) channels. In a previous study, forensic PwS (who committed violent offenses) identified spoken-emotions and integrated the emotional information from both channels similarly to controls. However, their performance indicated larger failures of selective-attention, and lower discrimination between spoken-emotions, than controls. Given that forensic schizophrenia represents a special subgroup, the current study compared forensic and non-forensic PwS. Forty-five PwS listened to sentences conveying four basic emotions presented in semantic or prosodic channels, in different combinations. They were asked to rate how much they agreed that the sentences conveyed a predefined emotion, focusing on one channel or on the sentence as a whole. Their performance was compared to that of 21 forensic PwS (previous study). The two groups did not differ in selective-attention. However, better emotional identification and discrimination, as well as better channel integration were found for the forensic PwS. Results have several clinical implications: difficulties in spoken-emotions processing might not necessarily relate to schizophrenia; attentional deficits might not be a risk factor for aggression in schizophrenia; and forensic schizophrenia might have unique characteristics as related to spoken-emotions processing (motivation, stimulation).

Could Expanding and Investing in First-Episode Psychosis Services Prevent Aggressive Behaviour and Violent Crime?

OBJECTIVE

Some persons developing, or presenting, schizophrenia engage in aggressive behaviour (AB) and/or criminal offending. Most of these individuals display AB prior to a first episode of psychosis (FEP). In fact, approximately one-third of FEP patients have a history of AB, some additionally display other antisocial behaviours (A+AB). The large majority of these individuals have presented conduct problems since childhood, benefit from clozapine, have extensive treatment needs, and are unlikely to comply with treatment. A smaller sub-group begin to engage in AB as illness onsets. A+AB persists, often for many years in spite of treatment-as-usual, until a victim is seriously harmed. This article proposes providing multi-component treatment programs at FEP in order to prevent aggressive and antisocial behaviours of persons with schizophrenia.

METHOD

Non-systematic reviews of epidemiological studies of AB among persons with schizophrenia, of the defining characteristics of sub-types of persons with schizophrenia who engage in AB and their responses to treatment, and of FEP service outcomes.

RESULTS

Studies have shown that mental health services that simultaneously target schizophrenia and aggressive behaviour are most effective both in reducing psychotic symptoms and aggressive behaviour. Evidence, although not abundant, suggests that a multi-component treatment program that would include the components recommended to treat schizophrenia and cognitive-behavioural interventions to reduce A+AB, and the other factors promoting A+AB such as substance misuse, victimisation, and poor recognition of emotions in the faces of others has the potential to effectively treat schizophrenia and reduce A+AB. Patients with a recent onset of AB would require few components of treatment, while those with prior conduct disorder would require all. Such a program of treatment would be long and intense.

CONCLUSIONS

Trials are needed to test the effectiveness of multi-component treatment programs targeting schizophrenia and A+AB at FEP. Studies are also necessary to determine whether providing such programs in hospitals and/or prisons, with long-term community after-care, and in some cases with court orders to participate in treatment, would enhance effectiveness. Whether investing at FEP would be cost-effective requires investigation.

Anabolic androgenic steroids, antisocial personality traits, aggression and violence

BACKGROUND

Anabolic androgenic steroid (AAS) use is associated with a wide range of adverse physical, psychological and social effects. While some experience few side effects, others might experience severe consequences. Aggression and violence are among the often-cited side effects associated with high-dose AAS use; however, most of the knowledge is generated from subgroups, such as prison populations. A likely hypothesis is that AAS use is associated with aggression and violence, but that these associations are complex and may be mediated by several factors, such as substance use, AAS dependence and personality traits.

METHODS

In the present study, we tested this hypothesis by examining the relations between long-term AAS use and AAS dependence, aggression, interpersonal violence and potential mediating factors in a sample of male AAS exposed and non-exposed weightlifting controls (WLC), using self-report questionnaires. Based upon AAS dependence criteria, a sample of male AAS users and WLC (N = 139) were stratified into three groups: WLC (n = 66), AAS dependents (n = 41) and AAS non-dependents (n = 32).

RESULTS

The results demonstrate that AAS dependents reported significantly higher levels of aggression compared to WLC and AAS non-dependents. While interpersonal violence was reported in all three groups, the highest percentage was found in the AAS dependent group.

CONCLUSION

In summary, our study confirms a link between AAS use, aggression and violence in a weightlifting population. However, the association is foremost seen in AAS dependent users and it seems that antisocial personality traits are an important mediator.

Facial emotion recognition in people with schizophrenia and a history of violence: a mediation analysis

Evidence for an association between impaired facial emotion recognition and violence in people with schizophrenia is inconclusive. In particular, the role of misidentification patterns involving specific emotions such as anger and the influence of clinical characteristics on this association remain unclear. In this study, we compared facial emotion recognition performance in age- and gender-matched schizophrenia spectrum disorders subjects with (N = 52) and without (N = 52) a history of violence. Data on current symptom severity, Cluster B personality status, past victimization, and alcohol and substance misuse were also collected. Compared to those without, subjects with a history of violence showed worse facial emotion recognition performances, involving anger, fear, disgust, sadness, and happiness. When formally testing the reporting of angry faces, evidence of enhanced sensitivity to anger was not supported. Finally, when the impact of current symptoms was assessed, higher severity of activation symptoms, including motor hyperactivity, elevated mood, excitement and distractibility, mediated the relationship between history of violence and poor facial emotion recognition performance. As a whole, our findings seem to support the role of perceptual deficits involving different emotions as well as of a mediation played by activation symptoms. Facial emotion recognition deficits associated with the propensity to violence, as well certain symptoms mediating their relationship, should be targeted by specific treatment approaches.

Victimization, violence and facial affect recognition in a community sample of first-episode psychosis patients

AIMS

This exploratory study is the first to examine previously identified variables of increased vulnerability to victimization, the prevalence of aggression in a cohort of patients with first-episode psychosis and the potential impact of impairments in facial affect recognition (FAR) on victimization.

METHODS

Sixty-nine male participants completed assessments of IQ, substance use, psychopathy, childhood trauma, aggressive behaviour and psychopathology. Participants were asked about violent victimization in the past year and charges for violent offences. FAR was assessed using the Animated Full Facial Comprehension Test.

RESULTS

The victimized group (n = 25) had significantly higher psychopathy traits (P = .042) and lower recognition of sadness (P < .01) compared to the non-victimized group (n = 44). Participants who reported charges for violent offences (n = 15) had significantly higher scores on measures of physical abuse in childhood (P < .01), substance use (P < .05 for cannabis, P < .001 for cocaine and amphetamine use), psychopathy traits (P < .01), psychopathology (P = .031) and lifetime aggressive behaviour (P < .01). The logistic regression models using FAR sadness and Psychopathic Personality Inventory-Revised (PPI-R) total score as predictors for victimization (χ ² [2] = 13.81, P = .001; Nagelkerke R ² = .30) and using physical abuse in childhood, PPI-R total score, and psychopathology as predictors for violent offences (χ ² [3] = 14.89, P = .002; Nagelkerke R ² = .36) were significant.

CONCLUSIONS

These findings highlight the value of considering victimization in psychotic illness from a social information processing perspective in addition to known clinical and lifestyle factors. Based on these results, future studies could explore the use of affect recognition training early in the course of the illness as a possible intervention to reduce victimization.

Gender differences in facial emotion recognition in persons with chronic schizophrenia

Background

The aim of the present study was to investigate possible sex differences in the recognition of facial expressions of emotion and to investigate the pattern of classification errors in schizophrenic males and females. Such an approach provides an opportunity to inspect the degree to which males and females differ in perceiving and interpreting the different emotions displayed to them and to analyze which emotions are most susceptible to recognition errors.

Methods

Fifty six chronically hospitalized schizophrenic patients (38 men and 18 women) completed the Penn Emotion Recognition Test (ER40), a computerized emotion discrimination test presenting 40 color photographs of evoked happy, sad, anger, fear expressions and neutral expressions balanced for poser gender and ethnicity.

Results

We found a significant sex difference in the patterns of error rates in the Penn Emotion Recognition Test. Neutral faces were more commonly mistaken as angry in schizophrenic men, whereas schizophrenic women misinterpreted neutral faces more frequently as sad. Moreover, female faces were better recognized overall, but fear was better recognized in same gender photographs, whereas anger was better recognized in different gender photographs.

Conclusions

The findings of the present study lend support to the notion that sex differences in aggressive behavior could be related to a cognitive style characterized by hostile attributions to neutral faces in schizophrenic men.

Processing of Emotions in Speech in Forensic Patients With Schizophrenia: Impairments in Identification, Selective Attention, and Integration of Speech Channels

Individuals with schizophrenia show deficits in recognition of emotions which may increase the risk of violence. This study explored how forensic patients with schizophrenia process spoken emotion by: (a) identifying emotions expressed in prosodic and semantic content separately, (b) selectively attending to one speech channel while ignoring the other, and (c) integrating the prosodic and the semantic channels, compared to non-clinical controls. Twenty-one forensic patients with schizophrenia and 21 matched controls listened to sentences conveying four emotions (anger, happiness, sadness, and neutrality) presented in semantic or prosodic channels, in different combinations. They were asked to rate how much they agreed that the sentences conveyed a predefined emotion, focusing on one channel or on the sentence as a whole. Forensic patients with schizophrenia performed with intact identification and integration of spoken emotions, but their ratings indicated reduced discrimination, larger failures of selective attention, and under-ratings of negative emotions, compared to controls. This finding doesn't support previous reports of an inclination to interpret social situations in a negative way among individuals with schizophrenia. Finally, current results may guide rehabilitation approaches matched to the pattern of auditory emotional processing presented by forensic patients with schizophrenia, improving social interactions and quality of life.

Cognition and violent behavior in psychotic disorders: A nationwide case-control study

Background

The excess risk of violence in psychotic disorders may partly be explained by impairments in executive functions (EFs) and theory of mind (ToM). However, previous studies have been limited by composite measures of EFs and small samples of inpatients.

Methods

Data were collected for the research project Genetic Risk and Outcome of Psychosis (GROUP). Patients with psychotic disorders (N = 891) were recruited from various care settings in the Netherlands. The following neuropsychological tests were administered (targeted cognitive function in parentheses): (i) Continuous Performance Test-HQ (inhibition); (ii) Response Shifting Task (cognitive flexibility); (iii) Wechsler Adult Intelligence Scale, Third Edition (WAIS-III) Block Design subtest (fluid intelligence); (iv) Neuropsychological Assessment Battery (NAB) Mazes Test (planning); (v) Degraded Facial Affect Recognition Task (affective ToM); and (vi) Hinting Task (cognitive ToM). Lifetime violence was ascertained from medical records and patient interviews. We used analysis of covariance to compare the mean scores of violent and nonviolent patients on each test, adjusting for age and sex.

Results

Violent patients performed significantly worse than nonviolent patients on the WAIS-III Block Design subtest (F [1, 847] = 5.12, p = .024), NAB Mazes Test (F [1, 499] = 5.32, p = .022) and Hinting Task (F [1, 839] = 9.38, p = .002). For the other tests, the between-group differences were nonsignificant. Violent behavior explained no more than 1% of the variance in performance on each test.

Conclusion

Impairments in EFs and ToM are unlikely to provide useful targets for risk assessment and interventions.

The last taboo: The experience of violence in first-episode psychosis caregiving relationships

OBJECTIVES

Informal caregiving relationships play an important role in facilitating recovery outcomes in psychosis. The relationship can serve as a source of positive experiences that co-exist alongside common challenges typically associated with mental health problems. People with psychosis, when compared to the general population, are more likely to perpetrate acts of violence, a relationship that is particularly evident during the first psychosis episode. Although victims of service user violence are typically people already known to them, such as informal carers, there remains a lack of understanding about their caring experiences and needs. This study sought to address gaps in the literature by exploring the subjective accounts of informal carers supporting a relative experiencing their first episode of psychosis who has also behaved violently towards them.

DESIGN

A cross-sectional design was employed.

METHODS

Individual semi-structured interviews, which were audio recorded and later transcribed for analyses, were undertaken with a convenience sample of eight carers drawn from a specialist early psychosis service. Interview questions focused on their experiences of patient violence, the subjective impact, and coping strategies. An interpretative phenomenological approach was used to analyse the data.

RESULTS

Participants were mostly living with their relative with psychosis and were typically female, parents, and from a black and minority ethnic background. Data analyses identified seven key themes from participant interviews including the lack of predictability over when the violence occurred, being scared and fearful, keeping quiet about what happens at home and in the caregiving relationship, and staying safe.

CONCLUSIONS

Reports by informal carers about experiencing violence and victimization from their relatives with psychosis are an important issue in some caregiving relationships during the first episode. Developing a more informed understanding of the specific needs of these carers and the caregiving relationship is indicated. The implications for service providers are discussed.

PRACTITIONER POINTS

Carers were exposed to a broad range of patient violence, which included being kicked and having weapons used against them. The violence typically occurred within carers' homes, when no other people were around. Patient violence impacted negatively on carer emotional and physical functioning, which included leaving carers living in fear of their own safety and what might become of their relative. The results highlight the importance of routinely asking first-episode carers about their experience of patient violence. The development of interventions (e.g., identification of early triggers, de-escalation) that are able to take account of the ongoing nature and complexity of the caregiving relationship but are purposefully aimed at supporting carers to remain safe in their relationship should be explored for their impact.

Large social cognitive impairments characterize homicide offenders with schizophrenia

Schizophrenia is associated with an increased violence risk, particularly homicide. One possible, but scarcely explored, contributor to the increased violence risk is social cognitive impairment. Individuals with schizophrenia show impairments in social cognition that are associated with poor functional outcome. This study examined social cognition among homicide offenders with schizophrenia (HOS), applying validated measures of emotion perception and theory of mind (ToM). Two groups of individuals with schizophrenia were compared, one had committed homicide (HOS, n = 26), and the other had no violence history (non-HOS, n = 28). Healthy controls (HC, n = 71) were included as reference group for one measure. Emotion perception was indexed by the Emotion in Biological Motion (Emotion) and Pictures of Facial Affect (PFA) tests. ToM was assessed with the Hinting Task and Movie for the Assessment of Social Cognition (MASC). The results showed that HOS participants had significantly poorer performance than non-HOS in both emotion perception and ToM. For the MASC test, HOS participants showed large deficits compared to HC (-4 standard deviations). Particularly, HOS participants made a substantial number of undermentalizing errors. The results suggest that emotion perception deficits and a tendency to undermentalize may be important for understanding homicide in schizophrenia.

Social functioning impairments in schizotypy when social cognition and neurocognition are not impaired

The present study examined the social, cognitive, and emotional functioning of persons with schizotypy. Over 2000 undergraduate students were screened for schizotypy with the Schizotypal Personality Questionnaire - Brief over two consecutive semesters. Ninety-two persons with high schizotypy and 22 persons with low schizotypy completed measures of social functioning (Social Adjustment Scale, Social Functioning Scale, MOS Social Support Survey), working memory (Paced Auditory Serial Addition Test, Digit Span, Letter-Number Sequencing, Corsi Block Tapping Test) and empathy (Interpersonal Reactivity Index, Empathy Quotient). Persons with high schizotypy, when compared to their counterparts with low schizotypy, displayed deficits on many indices of social functioning even though differences in working memory and empathy were not observed. The social functioning deficits of persons with high schizotypy included impairments in friendship relations, family relations, interpersonal engagement, and recreational activities. These findings indicate that persons with high schizotypy experience broad deficits in social functioning even when their cognitive and emotional skills are unaffected.

Emotional face recognition in male adolescents with autism spectrum disorder or disruptive behavior disorder: an eye-tracking study

Autism Spectrum Disorder (ASD), Oppositional Defiant Disorder (ODD), and Conduct Disorder (CD) are often associated with emotion recognition difficulties. This is the first eye-tracking study to examine emotional face recognition (i.e., gazing behavior) in a direct comparison of male adolescents with Autism Spectrum Disorder or Oppositional Defiant Disorder/Conduct Disorder, and typically developing (TD) individuals. We also investigate the role of psychopathic traits, callous-unemotional (CU) traits, and subtypes of aggressive behavior in emotional face recognition. A total of 122 male adolescents (N = 50 ASD, N = 44 ODD/CD, and N = 28 TD) aged 12-19 years (M = 15.4 years, SD= 1.9) were included in the current study for the eye-tracking experiment. Participants were presented with neutral and emotional faces using a Tobii 1750 eye-tracking monitor to record gaze behavior. Our main dependent eye-tracking variables were: (1) fixation duration to the eyes of a face and (2) time to the first fixation to the eyes. Since distributions of eye-tracking variables were not completely Gaussian, non-parametric tests were chosen to investigate gaze behavior across the diagnostic groups with Autism Spectrum Disorder, Oppositional Defiant Disorder/Conduct Disorder, and Typically Developing individuals. Furthermore, we used Spearman correlations to investigate the links with psychopathy, callous, and unemotional traits and subtypes of aggression as assessed by questionnaires. The relative total fixation duration to the eyes was decreased in both the Autism Spectrum Disorder group and the Oppositional Defiant Disorder/Conduct Disorder group for several emotional expressions. In both the Autism Spectrum Disorder and the Oppositional Defiant Disorder/Conduct Disorder group, increased time to first fixation on the eyes of fearful faces only was nominally significant. The time to first fixation on the eyes was nominally correlated with psychopathic traits and proactive aggression. The current findings do not support strong claims for differential cross-disorder eye-gazing deficits and for a role of shared underlying psychopathic traits, callous-unemotional traits, and aggression subtypes. Our data provide valuable and novel insights into gaze timing distributions when looking at the eyes of a fearful face.

Emotional facial recognition in proactive and reactive violent offenders

The purpose of this study is to analyse individual differences in the ability of emotional facial recognition in violent offenders, who were characterised as either reactive or proactive in relation to their offending. In accordance with findings of our previous study, we expected higher impairments in facial recognition in reactive than proactive violent offenders. To assess the ability to recognize facial expressions, the computer-based Facial Emotional Expression Labeling Test (FEEL) was performed. Group allocation of reactive und proactive violent offenders and assessment of psychopathic traits were performed by an independent forensic expert using rating scales (PROREA, PCL-SV). Compared to proactive violent offenders and controls, the performance of emotion recognition in the reactive offender group was significantly lower, both in total and especially in recognition of negative emotions such as anxiety (d = -1.29), sadness (d = -1.54), and disgust (d = -1.11). Furthermore, reactive violent offenders showed a tendency to interpret non-anger emotions as anger. In contrast, proactive violent offenders performed as well as controls. General and specific deficits in reactive violent offenders are in line with the results of our previous study and correspond to predictions of the Integrated Emotion System (IES, 7) and the hostile attribution processes (21). Due to the different error pattern in the FEEL test, the theoretical distinction between proactive and reactive aggression can be supported based on emotion recognition, even though aggression itself is always a heterogeneous act rather than a distinct one-dimensional concept.

Aggressive Behavior Among Persons With Schizophrenia and Those Who Are Developing Schizophrenia: Attempting to Understand the Limited Evidence on Causality

People with, and those who are developing, schizophrenia are at increased risk to engage in aggressive behavior (AGB). Some incidents lead to criminal prosecution. Most people with schizophrenia who commit crimes engage in delinquency and/or AGB prior to first episode. A large proportion of these individuals have a history of childhood conduct disorder (CD) and brain abnormalities suggestive of abnormal neural development distinctive from that of others with schizophrenia. Factors contributing to schizophrenia that is preceded by CD include failing to learn not-to-behave aggressively in early childhood, impairments in understanding emotions in the faces of others, maltreatment, and subsequent re-victimization. Others with no history of antisocial behavior begin engaging in AGB as positive symptoms increase and illness onsets. They too are at elevated risk to be victimized. Specific genetic variants linked to stress regulation in combination with adversity have been associated both with AGB and psychotic symptoms. Effectively treating conduct problems and preventing victimization would reduce AGB by persons with schizophrenia.

[Preventing violence in schizophrenia with cognitive remediation]

OBJECTIVES

The association between schizophrenia and violence represents an important issue in psychiatry. Often highly publicized, violent acts raise the question of their detection, prevention, management and treatment. There is no single, direct and exclusive link between aggressiveness and the underlying psychiatric disorder. On the contrary, the processes underlying this violence are multiple and interlinked. In addition to static and dynamic risk factors, cognitive deficits play an important role in the genesis and maintenance of violent and aggressive behavior.

METHODS

Using recent data from the international literature and the main databases, we first clarify the role played by cognitive deficits in the violence of patients with schizophrenia. We then evaluate the place of psychosocial interventions such as cognitive remediation and social cognitive training in managing the violent and aggressive behavior of these patients.

RESULTS

Executive functions and working memory are the most studied neurocognitive functions in the field of violence in schizophrenia. Impulsivity, lack of cognitive flexibility, lack of adaptation and inhibition of automatic motor responses, and altered anger regulation may explain this relationship. Three main components of social cognition are associated with violent behaviors in schizophrenia: (1) the recognition of facial emotions through the inoperability of systems of "emotional monitoring", violent inhibition and recognition of informative facial zones; (2) the theory of the mind through the erroneous interpretation of the intentions of others; (3) the attributional style through the preferentially aggressive over interpretation of social situations and weak capacities of introspection. Overall, cognitive biases inhibit response in a socially acceptable manner and increase the risk of responding impulsively and aggressively to a stressful or provocative situation. In this context, we studied the place held by psychosocial interventions in the management of the violent and aggressive behaviors of these patients. Various cognitive remediation programs have shown their feasibility in people with schizophrenia and neurocognitive deficits with a history of violence as well as their effectiveness in reducing violence, mainly by reducing impulsivity. Similarly, specific programs dedicated to social cognitive training such as Social Cognition and Interaction Training (SCIT), Reasoning and Rehabilitation Mental Health Program (R&R2 MHP) and Metacognitive Training (MCT) have shown their positive impact on the control and reduction of global aggressive attitudes and on the numbers of physical and verbal aggressive incidents in schizophrenia. The improvement of social cognition would be achieved through the amendment of interpersonal relationships and social functioning. These interventions are effective at different stages of disease progression, in patients with varied profiles, on violent attitudes in general and on the number of verbal and physical attacks, whether for in-patients or out-patients. Beneficial effects can last up to 12months after termination of the study program. The interest of these interventions is preventive if the subject never entered in a violent register or curative in case of a personal history of violence. This type of care can be considered from a symptomatic point of view by limiting downstream the heavy consequences of such acts, but also etiologically by acting on one of the causes of violent behavior. Compliance with the eligibility criteria, carrying out a prior functional analysis and confirmation of the major impulsive part of the patient's violence are prerequisites for the use of these programs. Similarly, the early introduction of such therapies, their repetition over time and the integration of the patient into a comprehensive process of psychosocial rehabilitation will ensure the best chance of success.

CONCLUSIONS

Some cognitive impairments appear to have their place in the genesis, progression and maintenance of violent acts of individuals with schizophrenia. Their management thus opens new therapeutic perspectives such as cognitive remediation, still rarely used in this aim, to complement the action of the traditional care tools. However, further therapeutic trials are needed before considering cognitive remediation and social cognitive training as central care modalities in the therapeutic control of violence in schizophrenia.

Cognitive remediation and social cognitive training for violence in schizophrenia: a systematic review

A significant correlation exists between violence and schizophrenia (SCZ). Recent studies matched some cognitive deficits like strong risk factors for violence with interesting applications in terms of treatment. Our objective was to conduct a systematic review of the effectiveness of cognitive remediation (CR) and social cognitive training (SCT) in the management of violent and aggressive behaviors in SCZ.

METHODS

The electronic databases Pubmed, Web of Science, Cochrane Library and ScienceDirect were searched in, using combinations of terms relating to SCZ, CR and violence. Studies were selected and data were extracted using a PRISMA statement. Inclusion criteria were adults with SCZ and a documented collection of disruptive and violent behaviors, for whom researchers had used a CR or SCT program.

RESULTS

Eleven studies were identified, two related to non-specific CR intervention and nine to codified CR or SCT programs. Results showed that these programs had a positive impact on the control and reduction of global aggressive attitudes and physical assaults. Therapeutic targets were social cognition and executive functions through the improvement of interpersonal relationships and impulsivity feature respectively. Effectiveness was proved at various stages of the illness, in different types of patients and units, with effects persisting for up to 12 months after interruption of CR. Conclusions are limited by some methodological restrictions.

CONCLUSION

Although current evidences need to be completed with further randomized studies, CR and SCT appear to be promising approaches in the management of violence in SCZ.

The relationship between childhood trauma, emotion recognition, and irritability in schizophrenia patients

This study investigated the relationship between childhood trauma, irritability, and emotion recognition, in schizophrenia patients during a psychotic break. Thirty-six schizophrenia inpatients and 36 healthy controls were assessed with the Irritability Questionnaire (IRQ) and two facial emotion recognition tasks, the Emotion Discrimination Test (EDT) and Emotion Identification Test (EIT). Patients were further assessed with the Structured Clinical Interview for DSM III-R Axis II Disorders (SCID-II), the Positive and Negative Symptom Scale (PANSS), and the Childhood Trauma Questionnaire-28 (CTQ-28). EDT and EIT performance was significantly impaired in patients compared to healthy controls. Furthermore, patients tended to misidentify sad, surprised, or angry faces as showing fear, and this misidentification correlated with the patients' irritability. Childhood adversity increased irritability both directly and indirectly through emotion misidentification.

New Clinically Relevant Findings about Violence by People with Schizophrenia

OBJECTIVE

To review findings with clinical relevance that add to knowledge about antisocial and aggressive behaviour among persons with schizophrenia.

METHOD

Nonsystematic literature review.

RESULTS

Recent evidence shows that individuals who develop schizophrenia present cognitive deficits, psychotic-like experiences, and internalizing and externalizing problems from childhood onwards. Many of their relatives present not only schizophrenia-related disorders but also antisocial behaviour. While the increased risk of aggressive behaviour among persons with schizophrenia has been robustly established, recent findings show that by first contact with clinical services for psychosis, most people with schizophrenia who will engage in aggressive behaviour may be identified. At first episode, 2 distinct types are distinguishable: those who present a history of antisocial and aggressive behaviour since childhood and those who began engaging in aggressive behaviour as illness onsets. Antipsychotic medications and other treatments shown to be effective for schizophrenia are needed by both types of patients. Additionally, those with a history of antisocial and aggressive behaviour since childhood require cognitive-behavioural programs aimed at reducing these behaviours and promoting prosocial behaviour. Reducing physical victimisation and cannabis use will likely reduce aggressive behaviour. Evidence suggests that threats to hurt others often precede assaults.

CONCLUSIONS

At first contact with services, patients with schizophrenia who have engaged in aggressive behaviour should be identified and treated for schizophrenia and for aggression. Research is needed to identify interactions between genotypes and environmental factors, from conception onwards, that promote and that protect against the development of aggressive behaviour among persons with schizophrenia.

Development, Administration, and Structural Validity of a Brief, Computerized Neurocognitive Battery: Results From the Army Study to Assess Risk and Resilience in Servicemembers

The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) is a research project aimed at identifying risk and protective factors for suicide and related mental health outcomes among Army Soldiers. The New Soldier Study component of Army STARRS included the assessment of a range of cognitive- and emotion-processing domains linked to brain systems related to suicidal behavior including posttraumatic stress disorder, mood disorders, substance use disorders, and impulsivity. We describe the design and application of the Army STARRS neurocognitive test battery to a sample of 56,824 soldiers. We investigate its structural and concurrent validity through factor analysis and correlation of scores with demographics. We conclude that, in addition to being composed of previously well-validated measures, the Army STARRS neurocognitive battery as a whole demonstrates good psychometric properties. Correlations of scores with age and sex differences mostly replicate previously published findings, highlighting moderate to large effect sizes even within this restricted age range. Factor structures of scores conform to theoretical expectations. This neurocognitive battery provides a brief, valid measurement of neurocognition that may be helpful in predicting mental health and military performance. These measures can be integrated with neuroimaging to offer a powerful tool for assessing neurocognition in Servicemembers.

Facial emotion perception impairments in schizophrenia patients with comorbid antisocial personality disorder

Impairment in facial emotion perception is believed to be associated with aggression. Schizophrenia patients with antisocial features are more impaired in facial emotion perception than their counterparts without these features. However, previous studies did not define the comorbidity of antisocial personality disorder (ASPD) using stringent criteria. We recruited 30 participants with dual diagnoses of ASPD and schizophrenia, 30 participants with schizophrenia and 30 controls. We employed the Facial Emotional Recognition paradigm to measure facial emotion perception, and administered a battery of neurocognitive tests. The Life History of Aggression scale was used. ANOVAs and ANCOVAs were conducted to examine group differences in facial emotion perception, and control for the effect of other neurocognitive dysfunctions on facial emotion perception. Correlational analyses were conducted to examine the association between facial emotion perception and aggression. Patients with dual diagnoses performed worst in facial emotion perception among the three groups. The group differences in facial emotion perception remained significant, even after other neurocognitive impairments were controlled for. Severity of aggression was correlated with impairment in perceiving negative-valenced facial emotions in patients with dual diagnoses. Our findings support the presence of facial emotion perception impairment and its association with aggression in schizophrenia patients with comorbid ASPD.

The fear of other persons' laughter: Poor neuronal protection against social signals of anger and aggression

The fear of other persons' laughter (gelotophobia) occurs in the context of several psychiatric conditions, particularly in the schizophrenia spectrum and social phobia. It entails severe personal and inter-personal problems including heightened aggression and possibly violence. Individuals with gelotophobia (n=30; 24 with social phobia or Cluster A diagnosis) and matched symptom-free controls (n=30) were drawn from a large screening sample (n=1440). EEG coherences were recorded during the confrontation with other people's affect expressions, to investigate the brain's modulatory control over the emotionally laden perceptual input. Gelotophobia was associated with more loose functional coupling of prefrontal and posterior cortex during the processing of expressions of anger and aggression, thus leaving the individual relatively unprotected from becoming affected by these social signals. The brain's response to social signals of anger/aggression and the accompanied heightened permeability for this kind of information explains the particular sensitivity to actual or supposed malicious aspects of laughter (and possibly of other ambiguous social signals) in individuals with gelotophobia, which represents the core feature of the condition. Heightened perception of stimuli that could be perceived as offensive, which is inherent in several psychiatric conditions, may be particularly evident in the fear of other persons' laughter.

Metacognition and general functioning in patients with schizophrenia and a history of criminal behavior

Metacognitive difficulties have been linked to social dysfunction in schizophrenia. However, research examining the role of metacognition in the social functioning of patients with a history of violence and criminality is very limited. This research is especially important for this group given their relatively poor prognosis and their risk to reoffend, as well as the promising benefits of integrating metacognitive approaches in psychosocial treatments. In this study, the association between metacognition and global social functioning was examined in 79 patients with schizophrenia with a criminal background. We also examined the association of positive, negative and disorganized symptoms with social functioning and the extent to which metacognition mediates this association. The results indicate that poor social functioning is associated with metacognitive difficulties and higher levels of delusions and Conceptual Disorganization. In addition, meditation analyses showed that metacognition accounted for about 11% of the total effect size of the association between delusions and social dysfunction, suggesting that the relationship between delusions and social dysfunction is partially driven by impaired metacognition. These findings underscore the importance of interventions designed to enhance the patients׳ metacognitive capacities, that is, the more proximal capacities linked to poorer social functioning.

Moral cognition in schizophrenia

INTRODUCTION

Disordered moral behaviour and understanding of moral rules were described early in the literature on schizophrenia; however, moral cognition has received scant attention in spite of a large literature focused on social cognitive impairments and violent behaviour in schizophrenia.

METHODS

We conducted a narrative synthesis of the literature on violence, moral judgement and schizophrenia.

RESULTS

Initial empirical research into moral cognition in schizophrenia did not fully account for the basic- and social-cognitive deficits now known to characterise schizophrenia. Importantly, research into moral cognition in autism and psychopathy, disorders in part characterised by social cognitive impairments indicates subtle patterns of difference to the moral cognition of control participants. Recent neuroeconomic studies of moral cognition in schizophrenia have indicated that individuals with schizophrenia display subtle dysfunction in their fairness-related behaviours, but not in their propensity to engage in altruistic punishment.

CONCLUSIONS

Further research has the potential to broaden our understanding of what is intact and what is impaired in moral cognition in schizophrenia and also to inform our theories of the structures subserving moral judgement in the general population. Furthermore, a more thorough understanding of moral cognitive impairments in schizophrenia may have implications for both legal process and psychosocial rehabilitation.

The Promise of Neurotechnology in Clinical Translational Science

Neurotechnology is broadly defined as a set of devices used to understand neural processes and applications that can potentially facilitate the brain's ability to repair itself. In the past decade, an increasingly explicit understanding of basic biological mechanisms of brain-related illnesses has produced applications that allow a direct yet noninvasive method to index and manipulate the functioning of the human nervous system. Clinical scientists are poised to apply this technology to assess, treat, and better understand complex socioemotional processes that underlie many forms of psychopathology. In this review, we describe the potential benefits and hurdles, both technical and methodological, of neurotechnology in the context of clinical dysfunction. We also offer a framework for developing and evaluating neurotechnologies that is intended to expedite progress at the nexus of clinical science and neural interface designs by providing a comprehensive vocabulary to describe the necessary features of neurotechnology in the clinic.

Laughter as a social rejection cue: gelotophobia and transient cardiac responses to other persons' laughter and insult

Other persons' laughter, normally perceived as a signal that persons are friendly and inviting others to approach, can also be perceived as a cue of social rejection. In this study, prerecorded laughter was placed in a realistic and personally relevant context, and participants' responses were related to gelotophobia, a trait predisposing to perceiving laughter as a cue of social rejection. Individuals with gelotophobia showed marked heart rate deceleration in response to the laughter stimulus, possibly indicating a "freezing-like" response. Moreover, cardiac responses to anger provocation by overtly insulting statements indicated heightened aggressive anger in response to cumulated social threat. The study adds to recent research showing specific cardiac responses to social rejection and to the literature on social rejection sensitivity by demonstrating the value of using well interpretable physiological measures in this research context.

Facial affect recognition performance and event-related potentials in violent and non-violent schizophrenia patients

We investigated whether male inpatients with schizophrenia and a history of hands-on violent offences (forensic schizophrenic, FOS) are more impaired in emotion recognition than matched schizophrenia patients without any history of violence (general psychiatric schizophrenic, GPS). This should become apparent in performance in psychometry and in scalp event-related brain potentials (ERPs) evoked by pictures of facial affect. FOS and GPS (each n = 19) were matched concerning age, intelligence, comorbid addiction, medication and illness duration. FOS revealed significantly poorer affect recognition (AR) performance, especially of neutral and fear stimuli. Analysis of ERPs revealed a significant interaction of hemisphere, electrode position and group of the N250 component. Post hoc analysis of group effect showed significantly larger amplitudes in FOS at FC3. These results support the hypothesis that in FOS emotional faces are more salient and evoke higher arousal. Larger impairment in AR performance combined with higher salience and arousal may contribute to the occurrence of violent acts in schizophrenia patients.

Psychopathy and facial emotion recognition ability in patients with bipolar affective disorder with or without delinquent behaviors

BACKGROUND

It is well known that patients with bipolar disorder are more prone to violence and have more criminal behaviors than general population. A strong relationship between criminal behavior and inability to empathize and imperceptions to other person's feelings and facial expressions increases the risk of delinquent behaviors. In this study, we aimed to investigate the deficits of facial emotion recognition ability in euthymic bipolar patients who committed an offense and compare with non-delinquent euthymic patients with bipolar disorder.

METHOD

Fifty-five euthymic patients with delinquent behaviors and 54 non-delinquent euthymic bipolar patients as a control group were included in the study. Ekman's Facial Emotion Recognition Test, sociodemographic data, Hare Psychopathy Checklist, Hamilton Depression Rating Scale and Young Mania Rating Scale were applied to both groups.

RESULTS

There were no significant differences between case and control groups in the meaning of average age, gender, level of education, mean age onset of disease and suicide attempt (p>0.05). The three types of most committed delinquent behaviors in patients with euthymic bipolar disorder were as follows: injury (30.8%), threat or insult (20%) and homicide (12.7%). The best accurate percentage of identified facial emotion was "happy" (>99%, for both) while the worst misidentified facial emotion was "fear" in both groups (<50%, for both). The total accuracy rate of recognition toward facial emotions was significantly impaired in patients with delinquent behaviors than non-delinquent ones (p<0.05). The accuracy rate of recognizing the fear expressions was significantly worse in the case group than in the control group (p<0.05). In addition, it tended to be worse toward angry facial expressions in criminal euthymic bipolar patients. The response times toward happy, fear, disgusted and angry expressions had been significantly longer in the case group than in the control group (p<0.05).

CONCLUSION

This study is the first, searching the ability of facial emotion recognition in euthymic patients with bipolar disorder who had delinquent behaviors. We have shown that patients with bipolar disorder who had delinquent behaviors may have some social interaction problems i.e., misrecognizing fearful and modestly anger facial emotions and need some more time to response facial emotions even in remission.

Violence among people with schizophrenia: phenotypes and neurobiology

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.

Mentalizing mediates the relationship between psychopathy and type of aggression in schizophrenia

Convincing evidence demonstrates that psychopathy is associated with premeditated aggression. However, studies have failed to explain why this association exists and whether socio-cognitive functions, such as mentalizing, could explain the relation. This cross-sectional study investigates, in 108 patients with schizophrenia, the association of psychopathy and mentalizing abilities with premeditated and impulsive aggression and probes the nature of their influence on these specific aggression patterns. Patients' engagement in premeditated aggression was associated with diminishing mentalizing and increasing psychopathic tendencies. Moreover, mediation analyses reveal that the ability to attribute mental states to others mediates the relation between psychopathy and type of aggression. This mediation is facilitated by a specific mentalizing profile characterized by the presence of intact cognitive and deficient emotional mentalizing capacities. This study is the first to report a mediating effect of mentalizing on the relationship between psychopathy and type of aggression in schizophrenia. Implications of these results are discussed.

Facial emotion perception abnormality in patients with early schizophrenia

BACKGROUND

Deficit in facial emotion perception is an important social cognitive impairment in schizophrenic patients, and it is one of the key determinants of functional outcome in schizophrenia. However, the moderating effect of social context and the boundary of perceptual categories of facial emotion perception remain unclear.

METHOD

A total of 36 schizophrenic outpatients in their early stage of illness and 43 healthy controls were recruited for evaluation of social and clinical characteristics, neurocognitive profiles, and facial emotion categorization (FEC) performance. FEC was assessed by a computer-based program with 120 trials, in which social context was presented in the form of a preceding question, in order to simulate the conditions of being praised (positive), blamed (negative), or inquiry (neutral), while the participants were asked to judge a photograph derived from one of the five facial images in a happy-angry emotion continuum. The FEC data was inserted into a logistic function model with subsequent analysis by repeated measures ANOVA and the shift point and slope as outcome measures.

RESULTS

Schizophrenic patients were significantly more likely to perceive ambiguous and subtle facial expressions as happy, rather than angry, in all three social contexts. However, the interaction effects between group and context for FEC performance was not significant.

CONCLUSIONS

Schizophrenic patients, even in their early stage of illness, appear to have abnormal perceptions of facial emotion categories, which may explain some of their abnormal social interactions and disabilities. This study provides additional information in understanding social cognitive deficits among schizophrenic patients.

Empathy, schizophrenia and violence: a systematic review

BACKGROUND

A small but significant association between schizophrenia and violence is open to a number of explanations. Impaired empathy has been associated with schizophrenia, and with violence in the general population. Our aim was to conduct a systematic review of any research into relationships between schizophrenia, empathy and violence.

METHODS

The electronic databases Medline, Psychinfo, Embase, Cochrane and DARE were searched using combinations of terms for schizophrenia, empathy and violence, as were selected journals and reference lists of relevant articles. Selection of studies and data extraction was done by each of us, blind to the other.

RESULTS

Six studies were identified, but sample selection, research procedures and empathy, illness and violence measures differed sufficiently between them that only descriptive analysis was possible. Apart from one single case study, sample sizes were between 24 (12 violent) and 116 (35 violent). A component of emotional empathy (emotion recognition) was measured in three of the studies, all of which showed some specific dysfunctional recognition related to violence. Cognitive empathy was measured in three studies, two linking impairments to violence and one not. Emotional responsiveness was measured in one study and no association with violence was found.

CONCLUSION

Although evidence is inconclusive on empathy impairment as a mediator of violence by people with chronic psychosis, it's likely relevance is most apparent in the better controlled studies. Larger scale studies are indicated with rigorous control for comorbidities.

Neuroimaging and neurocognitive correlates of aggression and violence in schizophrenia

Individuals diagnosed with major mental disorders such as schizophrenia are more likely to have engaged in violent behavior than mentally healthy members of the same communities. Although aggressive acts can have numerous causes, research about the underlying neurobiology of violence and aggression in schizophrenia can lead to a better understanding of the heterogeneous nature of that behavior and can assist in developing new treatment strategies. The purpose of this paper is to review the recent literature and discuss some of the neurobiological correlates of aggression and violence. The focus will be on schizophrenia, and the results of neuroimaging and neuropsychological studies that have directly investigated brain functioning and/or structure in aggressive and violent samples will be discussed as well as other domains that might predispose to aggression and violence such as deficits in responding to the emotional expressions of others, impulsivity, and psychopathological symptoms. Finally gender differences regarding aggression and violence are discussed. In this context several methodological and conceptional issues that limited the comparison of these studies will be addressed.

Potential markers of aggressive behavior: the fear of other persons' laughter and its overlaps with mental disorders

Background

Anecdotal evidence suggested that some outbreaks of aggression and violence may be related to a fear of being laughed at and ridiculed. The present study examined the potential association of the fear of other persons' laughter (gelotophobia) with emotion-related deficits predisposing for aggression, anger and aggression proneness, and its overlaps with relevant mental disorders.

Methodology/Principal Findings

Gelotophobic individuals were compared to a non-phobic control group with respect to emotion regulation skills and strategies, alexithymia, anger proneness, and aggressive behavior. Social phobia was diagnosed using the Structural Clinical Interview (SCID-I) for DSM IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition). Additionally, the SCID-II modules for Cluster A Personality Disorders, which includes schizoid, paranoid, and schizotypal personality disorder were administered to all participants. The findings show that gelotophobia is associated with deficits in the typical handling of an individual's own affective states, greater anger proneness and more aggressive behavior according to self-report as compared to non-phobic individuals. 80% of the subjects in the gelotophobia group had an additional diagnosis of social phobia and/or Cluster A personality disorder. The additional diagnoses did not predict additional variance of anger or aggressive behavior as compared to gelotophobia alone.

Conclusions/Significance

Features related to aggression and violence that are inherent in mental disorders such as social phobia and Cluster A personality disorders may be particularly evident in the symptom of fear of other persons' laughter.

Challenges and opportunities for genomic developmental neuropsychology: examples from the Penn-Drexel collaborative battery

Genomics has been revolutionizing medicine over the past decade by offering mechanistic insights into disease processes and engendering the age of "individualized medicine." Because of the sheer number of measures generated by gene sequencing methods, genomics requires "Big Science" where large datasets on genes are analyzed in reference to electronic medical record data. This revolution has largely bypassed the behavioral neurosciences, mainly because of the paucity of behavioral data in medical records and the labor-intensity of available neuropsychological assessment methods. We describe the development and implementation of an efficient neuroscience-based computerized battery, coupled with a computerized clinical assessment procedure. This assessment package has been applied to a genomic study of 10,000 children aged 8-21, of whom 1000 also undergo neuroimaging. Results from the first 3000 participants indicate sensitivity to neurodevelopmental trajectories. Sex differences were evident, with females outperforming males in memory and social cognition domains, while for spatial processing males were more accurate and faster, and they were faster on simple motor tasks. The study illustrates what will hopefully become a major component of the work of clinical and research neuropsychologists as invaluable participants in the dawning age of Big Science neuropsychological genomics.

Self-report and laboratory measures of impulsivity in patients with schizophrenia or schizoaffective disorder and healthy controls

This study examined self-reported impulsivity and aggression and performance on the stop-signal task in patients with schizophrenia or schizoaffective disorder and healthy volunteers. Compared to controls, patients had higher scores on interview and questionnaire measures of impulsivity and aggression and showed increased stop-signal reaction time and greater response variability. These findings are consistent with a specific impairment in response inhibition in schizophrenia.

An exploration of criminal thinking styles among civil psychiatric patients

BACKGROUND

Several studies have found a relationship between psychiatric illness and criminal behaviour. Despite this, few studies have examined the presence of criminal thinking among civil psychiatric patients.

AIMS

The aim of this study is to explore the patterns and correlates of criminal thinking, using the Psychological Inventory of Criminal Thinking Styles (PICTS), in a sample of civil psychiatric patients.

METHOD

The PICTS (Layperson Edition) and the Brief Psychiatric Rating Scale (Anchored Version; BPRS) were administered to 76 civil psychiatric patients. PICTS scores were compared with those of offenders from a previously published study. Bivariate tests were conducted between selected PICTS scales, BPRS factors, demographic and criminal history variables. Stepwise multiple regressions were performed to assess those variables that predicted the general criminal thinking, proactive and reactive composite scales of the PICTS.

RESULTS

Independent samples t-tests revealed that five PICTS thinking styles were significantly higher in the psychiatric sample compared with the comparison sample of criminal offenders. Bivariate correlations revealed that the PICTS proactive composite scale was significantly related to and predicted by substance abuse and arrest history. CONCLUSIONS/CLINICAL IMPLICATIONS: Thinking styles which are typically associated with criminality were found in this sample of civil psychiatric patients. Cognitive remediation strategies targeting these may help to prevent criminal activity in psychiatric patients.

Violent behaviour among people with schizophrenia: a framework for investigations of causes, and effective treatment, and prevention

Robust evidence has accumulated showing that individuals who develop schizophrenia are at elevated risk when compared to the general population to engage in violence towards others. This violence impacts negatively on victims as well as perpetrators and poses a significant financial burden to society. It is posited that among violent offenders with schizophrenia there are three distinct types defined by the age of onset of antisocial and violent behaviour. The early starters display a pattern of antisocial behaviour that emerges in childhood or early adolescence, well before illness onset, and that remains stable across the lifespan. The largest group of violent offenders with schizophrenia show no antisocial behaviour prior to the onset of the illness and then repeatedly engage in aggressive behaviour towards others. A small group of individuals who display a chronic course of schizophrenia show no aggressive behaviour for one or two decades after illness onset and then engage in serious violence, often killing, those who care for them. We hypothesize that both the developmental processes and the proximal factors, such as symptoms of psychosis and drug misuse, associated with violent behaviour differ for the three types of offenders with schizophrenia, as do their needs for treatment.