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Rolin SA, Caffrey D, Flores MG, Pope LG, Mootz J, Bello I, Nossel I, Compton MT, Stanley B, Wainberg M, Dixon LB, Appelbaum PS. An open pilot trial of a behavioural intervention to reduce violence by young adults with early psychosis receiving treatment in an early intervention services setting: A protocol. Early Interv Psychiatry 2024. [PMID: 38705578 DOI: 10.1111/eip.13543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 04/15/2024] [Accepted: 04/22/2024] [Indexed: 05/07/2024]
Abstract
AIMS Despite the public health impact of violence among young adults with psychosis, behavioural interventions to reduce the risk of engaging in violence remain rare. For young adults with early psychosis, cognitive behavioural therapy (CBT)-based psychotherapy has efficacy in reducing impairment and improving functioning. However, no CBT-based intervention to reduce violence has been formally adapted for young adults with early psychosis. This protocol outlines the first clinical trial of a behavioural intervention to reduce violence for young adults with early psychosis. This study is set in an early intervention services (EIS) setting and seeks to adapt and pilot Psychological Intervention for Complex PTSD and Schizophrenia-Spectrum Disorder (PICASSO), a CBT-based intervention, through an iterative process utilizing mixed-methods assessments. METHODS All research will occur at OnTrackNY, the largest EIS program in the United States. This study will consist of an open pilot trial, with four EIS clinicians delivering the intervention to one to two EIS participants per round. In this mixed-methods study, both quantitative measures (acceptability, feasibility and hypothesized mediators of target outcome collected on a weekly basis) and qualitative interviews (with EIS clinicians at weeks 4, 8 and 12) will be conducted. Transcripts will be analyzed using thematic content analysis. Two to three rounds of iterative modifications are anticipated (n = 10-16 EIS participants total). RESULTS Recruitment began in February 2024 and is expected to continue over a 9-12-month period. CONCLUSIONS Because violent behaviour causes interpersonal disruptions such as incarceration and increased caregiver burden, an innovative intervention to reduce violence risk could have broader health impact for this vulnerable population. Adapting the PICASSO intervention to the EIS setting will optimize its acceptability and feasibility by the intended target population.
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Affiliation(s)
- Stephanie A Rolin
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Deirdre Caffrey
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
| | - Megan G Flores
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Leah G Pope
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
| | - Jennifer Mootz
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
| | - Iruma Bello
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
| | - Ilana Nossel
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
| | - Michael T Compton
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
| | - Barbara Stanley
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
| | - Milton Wainberg
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
| | - Lisa B Dixon
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
| | - Paul S Appelbaum
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
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Lambe S, Cooper K, Fazel S, Freeman D. Psychological framework to understand interpersonal violence by forensic patients with psychosis. Br J Psychiatry 2024; 224:47-54. [PMID: 37861077 PMCID: PMC10807973 DOI: 10.1192/bjp.2023.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/23/2023] [Accepted: 09/04/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Forensic patients with psychosis often engage in violent behaviour. There has been significant progress in understanding risk factors for violence, but identification of causal mechanisms of violence is limited. AIMS To develop a testable psychological framework explaining violence in psychosis - grounded in patient experience - to guide targeted treatment development. METHOD We conducted in-depth interviews with 20 patients with psychosis using forensic psychiatric services across three regions in England. Interviews were analysed using reflexive thematic analysis. People with lived experience contributed to the analysis. RESULTS Analysis of interviews identified several psychological processes involved in the occurrence of violence. Violence was the dominant response mode to difficulties that was both habitual and underpinned by rules that engaged and justified an attack. Violence was triggered by a trio of sensitivities to other people: sensitivity to physical threat, from which violence protected; sensitivity to social disrespect, by which violence increased status; and sensitivity to unfairness, by which violence delivered revenge. Violence was an attempt to regulate difficult internal states: intense emotions were released through aggression and violence was an attempt to escape being overwhelmed by voices, visions or paranoia. There were different patterns of emphasis across these processes when explaining an individual participant's offending behaviour. CONCLUSIONS The seven-factor model of violence derived from our analysis of patient accounts highlights multiple modifiable psychological processes that can plausibly lead to violence. The model can guide the research and development of targeted treatments to reduce violence by individuals with psychosis.
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Affiliation(s)
- Sinéad Lambe
- Department of Experimental Psychology, University of Oxford, Oxford, UK; and Oxford Health NHS Foundation Trust, Oxford, UK
| | - Kate Cooper
- Department of Psychology, University of Bath, Bath, UK
| | - Seena Fazel
- Oxford Health NHS Foundation Trust, Oxford, UK; and Department of Psychiatry, University of Oxford, Oxford, UK
| | - Daniel Freeman
- Department of Experimental Psychology, University of Oxford, Oxford, UK; and Oxford Health NHS Foundation Trust, Oxford, UK
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Saba P, Qi H, Saleem A, Chen IJ, Kausar FN, Iqbal MF. Effects of Animated Movies on the Aggression and Behavior Performance of Primary School Students and Their Control Using a Cognitive Behavioral Anger-Control Training (CBACT) Program. Behav Sci (Basel) 2023; 13:659. [PMID: 37622799 PMCID: PMC10451846 DOI: 10.3390/bs13080659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/12/2023] [Accepted: 07/27/2023] [Indexed: 08/26/2023] Open
Abstract
This work is a combination of two studies, Study I and Study II, which aimed to examine the impact of animated movies on the aggression and behavioral performance of primary school students, as well as their control using the CBACT program. In Study I, the influence of animated movies on 300 students from ten primary schools in Pakistan with gender differences (50% male), family systems, and viewing time duration was examined. This study was performed on 7- to 9-year-old children on four subscales of the Buss-Perry aggression questionnaire (BPAQ), three subscales of the child behavior questionnaire (CBQ), and toy selection. Following that, in Study II the CBACT intervention was applied to aggressive students (n = 46) selected from Study I. Students were randomly divided into CBACT treatment (50%) and control groups. The results of Study I indicated that violent animated movies had a greater impact on the aggressive behavior of male students than on that of females, while girls were more affected by watching nonviolent movies. Furthermore, male viewers from nuclear families and females from joint families showed more aggressive problems. It was also observed that aggression in students significantly increased (p < 0.001) with increasing viewing animation time duration (10 to 30 min). The results of Study II showed that aggression in the treatment group was significantly reduced (p = 0.000) with the CBACT program but remained constant for the control group. The findings of Study I showed that violent animation is strongly linked with aggression and behavioral performance in primary school students. The CBACT program in Study II indicates that students may not be completely eliminated from watching violent movies, but their aggression levels were reduced when they watched animated movies. Therefore, the CBACT program opens a new window into behavioral problem treatment, which is casually influenced by violent media.
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Affiliation(s)
- Ponam Saba
- School of Education, Soochow University, Suzhou 215123, China; (H.Q.); (F.N.K.)
| | - Haiwen Qi
- School of Education, Soochow University, Suzhou 215123, China; (H.Q.); (F.N.K.)
| | - Atif Saleem
- School of Education, Huaibei Normal University, Huaibei 235000, China;
| | - I-Jun Chen
- School of Education, Soochow University, Suzhou 215123, China; (H.Q.); (F.N.K.)
| | - Fahd Naveed Kausar
- School of Education, Soochow University, Suzhou 215123, China; (H.Q.); (F.N.K.)
- School of Education, Minhaj University Lahore, Lahore 54700, Pakistan
| | - Muhammad Farhan Iqbal
- Department of Education, Qurtuba University of Science and Information Technology, Dera Ismail Khan 29050, Pakistan
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Okasha TA, Omar AN, Elserafy D, Serry S, Rabie ES. Violence in relation to cognitive deficits and symptom severity in a sample of Egyptian patients with schizophrenia. Int J Soc Psychiatry 2022; 69:689-699. [PMID: 36331135 DOI: 10.1177/00207640221132706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Patient with schizophrenia are significantly more likely to be violent than general population; and the consequences of this violence risk are often very serious for the patients, their caregivers, and the entire community. AIM To assess the risk of violence in patients with schizophrenia and its correlation with severity of symptoms and cognitive functions. METHODS A cross-sectional comparative study conducted in Okasha institute of psychiatry including 50 patients with schizophrenia compared to 50 healthy control group regarding violence risk as assessed by Historical, Clinical, and Risk Management-20 (HCR-20), case group was assessed using Structured Clinical Interview for DSM-IV (SCID-I), Positive and Negative Syndrome Scale (PANSS), cognitive functions were assessed by Wechsler Adult Intelligence Scale (WAIS), Trail Making Test (TMT) Part A and B, the Wisconsin Card Sorting Test (WCST), and the Wechsler Memory Scale (WMS). RESULTS There was a statistically significant difference between case and control groups regarding risk of violence where 58% of the case group were found to have risk of violence compared to only 18% in the control group. There was a significant correlation between this risk of violence and period of untreated psychosis, no of episodes, and history of substance use; also was significantly correlated with PANSS and Wisconsin card sorting test subscales. Regarding logistic regression analysis for factors affecting violence risk; total PANSS score and history of substance use were significant independent factors that increase violence risk. CONCLUSION Violence risk in patient with schizophrenia is a cardinal factor that may affect life of the patients, their family, and society; this risk can be affected by different factors including severity of symptoms, no of episodes, history of substance use, and cognitive function of the patients.
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Affiliation(s)
| | | | - Doha Elserafy
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Samar Serry
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Eman S Rabie
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Rolin SA, Scodes J, Dambreville R, Nossel IR, Bello I, Wall MM, Scott Stroup T, Dixon LB, Appelbaum PS. Feasibility and Utility of Different Approaches to Violence Risk Assessment for Young Adults Receiving Treatment for Early Psychosis. Community Ment Health J 2022; 58:1130-1140. [PMID: 34981276 PMCID: PMC8723812 DOI: 10.1007/s10597-021-00922-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/17/2021] [Indexed: 12/24/2022]
Abstract
This pilot study examined violence risk assessment among a sample of young adults receiving treatment for early psychosis. In this study, thirty participants were assessed for violence risk at baseline. Participants completed follow-up assessments at 3, 6, 9 and 12 months to ascertain prevalence of violent behavior. Individuals were on average 24.1 years old (SD = 3.3 years) and predominantly male (n = 24, 80%). In this sample, six people (20%) reported engaging in violence during the study period. Individuals who engaged in violence had higher levels of negative urgency (t(28) = 2.21, p = 0.035) This study sought to establish the feasibility, acceptability, and clinical utility of violence risk assessment for clients in treatment for early psychosis. Overall, this study found that most individuals with early psychosis in this study (who are in treatment) were not at risk of violence. Findings suggest that violent behavior among young adults with early psychosis is associated with increased negative urgency.
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Affiliation(s)
- Stephanie A Rolin
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, Suite 1300, New York, NY, 10032, USA.
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA.
| | - Jennifer Scodes
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Renald Dambreville
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Ilana R Nossel
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, Suite 1300, New York, NY, 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Iruma Bello
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, Suite 1300, New York, NY, 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Melanie M Wall
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, Suite 1300, New York, NY, 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - T Scott Stroup
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, Suite 1300, New York, NY, 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Lisa B Dixon
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, Suite 1300, New York, NY, 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Paul S Appelbaum
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, Suite 1300, New York, NY, 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
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Moulin V, Framorando D, Gasser J, Dan-Glauser E. The Link Between Cannabis Use and Violent Behavior in the Early Phase of Psychosis: The Potential Role of Impulsivity. Front Psychiatry 2022; 13:746287. [PMID: 35392388 PMCID: PMC8980530 DOI: 10.3389/fpsyt.2022.746287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 02/22/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Recently, the literature has shown that Cannabis Use (CU) was a risk factor for Violent Behavior (VB) in patients with psychosis, and those in the early phase of psychosis (EPP). These findings are relevant because of the high prevalence of CU in this EPP, and the potential for prevention during this phase of illness. However, there is still a lack of clear explanations, supported by empirical evidence, about what underlies the link between CU and VB against other. METHOD This viewpoint reviews the scientific literature on the link between CU and VB, and the involvement of impulsivity in this relationship. This last point will be addressed at clinical and neurobiological levels. RESULTS Recent studies confirmed that CU is particularly high in the EPP, and is a risk factor for VB in the EPP and schizophrenia. Studies have also shown that impulsivity is a risk factor for VB in psychosis, is associated with CU, and may mediate the link between CU and VB. Research suggests a neurobiological mechanism, as CU affects the structures and function of frontal areas, known to play a role in impulsive behavior. CONCLUSION Scientific evidence support the hypothesis of an involvement of impulsivity as a variable that could mediate the link between CU and aggression, particularly, when CU has an early onset. However, this hypothesis should be confirmed with longitudinal studies and by taking into account confounding factors. The studies highlight the relevance of early prevention in the EPP, in addition to interventions focusing on psychotic disorders.
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Affiliation(s)
- Valerie Moulin
- Unit for Research in Legal Psychiatry and Psychology, Institute of Forensic Psychiatry, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - David Framorando
- Unit for Research in Legal Psychiatry and Psychology, Institute of Forensic Psychiatry, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Jacques Gasser
- Unit for Research in Legal Psychiatry and Psychology, Institute of Forensic Psychiatry, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Elise Dan-Glauser
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland
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Affiliation(s)
- Margo D M Faay
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands (Faay); Department of Biomedical Sciences of Cells and Systems and Department of Psychiatry, University Medical Center Groningen, Groningen, the Netherlands (Sommer)
| | - Iris E Sommer
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands (Faay); Department of Biomedical Sciences of Cells and Systems and Department of Psychiatry, University Medical Center Groningen, Groningen, the Netherlands (Sommer)
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