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Hodgins S, Sivertsson F, Beckley A, Luigi M, Carlsson C. The burden for clinical services of persons with an intellectual disability or mental disorder convicted of criminal offences: A birth cohort study of 14,605 persons followed to age 64. Nord J Psychiatry 2024:1-10. [PMID: 38613517 DOI: 10.1080/08039488.2024.2337192] [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] [Received: 10/23/2023] [Accepted: 03/19/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Intellectual disability (ID), schizophrenia spectrum disorder (SSD), bipolar disorder (BD), substance use disorder (SUD), and other mental disorders (OMDs) are associated with increased risks of criminality relative to sex-matched individuals without these conditions (NOIDMD). To resource psychiatric, addiction, and social services so as to provide effective treatments, further information is needed about the size of sub-groups convicted of crimes, recidivism, timing of offending, antecedents, and correlates. Stigma of persons with mental disorders could potentially be dramatically reduced if violence was prevented. METHODS A birth cohort of 14,605 persons was followed to age 64 using data from Swedish national health, criminal, and social registers. RESULTS Percentages of group members convicted of violence differed significantly: males NOIDMD, 7.3%, ID 29.2%, SSD 38.6%, BD 30.7%; SUD 44.0%, and OMD 19.3%; females NOIDMD 0.8%, ID 7.7%, SSD 11.2%, BD 2.4%, SD 17.0%, and OMD 2.1%. Violent recidivism was high. Most violent offenders in the diagnostic groups were also convicted of non-violent crimes. Prior to first diagnosis, convictions (violent or non-violent) had been acquired by over 90% of the male offenders and two-thirds of the female offenders. Physical victimization, adult comorbid SUD, childhood conduct problems, and adolescent substance misuse were each associated with increased risks of offending. CONCLUSION Sub-groups of cohort members with ID or mental disorders were convicted of violent and non-violent crimes to age 64 suggesting the need for treatment of primary disorders and for antisocial/aggressive behavior. Many patients engaging in violence could be identified at first contact with clinical services.
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Affiliation(s)
- Sheilagh Hodgins
- Département de psychiatrie et addictologie, Université de Montréal, and Centre de Recherche Institut national de psychiatrie légale Philippe-Pinel, Centre de Recherche Institut national de psychiatrie légale Philippe-Pinel, Montreal, Canada
| | | | - Amber Beckley
- School of Behavioural, Social and Legal Sciences, Örebro University, Örebro, Sweden
| | - Mimosa Luigi
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Christoffer Carlsson
- Department of Criminology, Stockholm University, Stockholm, Sweden
- Institute for Futures Studies, Stockholm, Sweden
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Vos MKD, Giesbers G, Hülsken J. Relationships Between Early Maladaptive Schemas and Emotional States in Individuals With Sexual Convictions. SEXUAL ABUSE : A JOURNAL OF RESEARCH AND TREATMENT 2024; 36:233-250. [PMID: 36943900 DOI: 10.1177/10790632231153635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
This study seeks to add to the existing knowledge and available literature on schema therapy elements in forensic inpatient samples. Early maladaptive schemas and emotional states were assessed in Dutch individuals with sexual convictions and compared to individuals with nonsexual violent convictions. Self-ratings of the Young Schema Questionnaire and the Schema Mode Inventory of 95 patients with either convictions for child sexual abuse (N = 30), sexual violence against adults (N = 34), and nonsexual violent convictions (N = 31) were examined using one-way multivariate ANOVAs. Regardless of victim type, forensic patients convicted for sexual offending, and patients with convictions for nonsexual violent offending, seem to make equal use of specific maladaptive cognitive schemas and schema modes during mandated inpatient care. Other studies have shown that people with sexual offense histories are typically characterized by insecure attachment, overvigilance towards women, or a child-like self-concept. Our study indicates that forensic patient in Dutch mandated care may be qualitatively different from typical patients with sexual offense histories and that Dutch patients with violent or sexual offense histories are more similar than they are dissimilar.
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Affiliation(s)
- Marije Keulen-de Vos
- Forensic Psychiatric Center de Rooyse Wissel, Venray, Netherlands
- Radboud University, Faculty of Social Sciences, Nijmegen, the Netherlands
| | - Geertje Giesbers
- Forensic Psychiatric Hospital Pompe Foundation, Zeeland, the Netherlands
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3
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Ceballos NA, Watt TT. The Influence of Adverse Childhood Experiences on Malevolent Creativity in Young Adulthood. Behav Sci (Basel) 2023; 13:961. [PMID: 38131817 PMCID: PMC10740602 DOI: 10.3390/bs13120961] [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: 10/19/2023] [Revised: 11/15/2023] [Accepted: 11/21/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Childhood trauma may increase the risk of antisocial behavior in young adulthood. Our study examined the relationship between Adverse Childhood Experiences (ACEs) and the specific antisocial behavior of malevolent creativity (MC), the application of original ideas to purposely harm others, often to gain an unfair advantage through manipulation, threat, or harm. METHODS We surveyed college students (N = 524; 78% women) on demographics, ACEs, empathy, social support, coping, general creativity, and malevolent creativity. The data were analyzed via sequential linear regression models. RESULTS Reporting ≥ 4 ACEs was associated with increased MC, which remained significant when general creativity and demographics were controlled. The association between higher ACEs and MC was no longer significant when psychosocial control variables (social support, empathy, and coping) were included in the statistical model. Social support and empathy were negatively associated with MC, while coping and MC were positively associated. CONCLUSIONS ACEs may increase the likelihood of malevolent creativity in young adulthood, but empathy and social support may disrupt this trajectory. Care should be taken that coping skills, while typically viewed as a positive addition to one's behavioral repertoire, do not push individuals toward over-reliance on themselves, which may reduce prosocial behaviors and increase MC.
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Affiliation(s)
| | - Toni Terling Watt
- Department of Sociology, Texas State University, San Marcos, TX 78666, USA;
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4
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Guo W, Gu Y, Zhou J, Wang X, Sun Q. Characteristics and associated factors of violence in male patients with schizophrenia in China. Front Psychiatry 2023; 14:1106950. [PMID: 36970285 PMCID: PMC10036402 DOI: 10.3389/fpsyt.2023.1106950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 02/27/2023] [Indexed: 03/12/2023] Open
Abstract
ObjectiveTo investigate the characteristics and associated factors of violence in male patients with schizophrenia in China.MethodsA total of 507 male patients with schizophrenia were recruited, including 386 non-violent and 121 violent patients. The socio-demographic information and medical history of the patients were collected. Psychopathological characteristics, personality traits psychopathology, and factors related to risk management were assessed using the Brief Psychiatric Rating Scale (BPRS), the History of Violence, Clinical, Risk Assessment Scale (HCR-20), and the Psychopathy Checklist-Revised (PCL-R), as appropriate. Differences in these factors were compared between the violent and non-violent patients, and logistic regression analysis was performed to explore the risk factors for violence in male patients with schizophrenia.ResultsThe results showed that the violent group had a lower level of education, longer duration of illness, as well as a higher rate of hospitalization, history of suicidal attempts, and history of alcohol compared with the non-violent group. The violent group scored higher in items of symptoms in BPRS, personality traits and psychopathy in PCL-R, and risk management in HCR-20. The regression analysis showed that previous suicidal behavior (OR = 2.07,95% CI [1.06-4.05], P = 0.033), antisocial tendency in PCL-R (OR = 1.21, 95% CI [1.01-1.45], P = 0.038), H2: young age at violent incident (OR = 6.39, 95% CI [4.16-9.84], P < 0.001), C4: impulsivity (OR = 1.76, 95% CI [1.20-2.59], P = 0.004), and H3: relationship instability (OR = 1.60, 95% CI [1.08-2.37], P = 0.019) in HCR-20 were risk factors of violence among male patients with schizophrenia.ConclusionThe present study found significant differences in socio-demographic information, history of treatment, and psychopathy characteristics between male patients with schizophrenia who had engaged in violent behaviors and their non-violent counterparts in China. Our findings suggested the necessity of individualized treatment for male patients with schizophrenia who had engaged in violent behaviors as well as the use of both HCR-20 and PCL-R for their assessment.
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Affiliation(s)
- Weilong Guo
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, Hunan, China
| | - Yu Gu
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, Hunan, China
| | - Jiansong Zhou
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, Hunan, China
| | - Xiaoping Wang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, Hunan, China
| | - Qiaoling Sun
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, Hunan, China
- *Correspondence: Qiaoling Sun,
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Li J, Ouyang L, Liu X, Wang Q, Min Z, Liu G, Zhong Y, Zhang N, Wang C, Liu N. The influence of NOS1AP gene polymorphisms and childhood abuse on antisocial personality disorder in Chinese male violent inmates. Personal Ment Health 2022; 17:184-193. [PMID: 36463909 DOI: 10.1002/pmh.1572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 11/02/2022] [Accepted: 11/13/2022] [Indexed: 12/07/2022]
Abstract
Antisocial personality disorder (ASPD) is a common behavioral pattern that causes sufferers to ignore or violate the rights of others. Though its cause is still unclear, previous studies have shown that childhood maltreatment is closely related to ASPD. The NOS1AP gene is associated with various neuropsychiatric diseases, but a linkage between it and ASPD has not yet been discovered. This study recruited ASPD and non-ASPD male subjects who had committed violent crimes from a prison in Nanjing, China. By comparing the two groups' genotypes, allele frequencies, and histories of childhood abuse, we explored the interaction between the NOS1AP gene and childhood maltreatment on the pathogenesis of ASPD. The results showed that polymorphism rs945713 in the NOS1AP gene was associated with ASPD and furthermore that this SNP may be involved in regulating the effect of childhood abuse on ASPD. This study found that childhood trauma increases the risk of ASPD in violent adult male inmates; for prisoners with ASPD, it is critical to pay attention to their childhood trauma and take early psychological intervention.
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Affiliation(s)
- Jinyang Li
- The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lichen Ouyang
- The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xinyao Liu
- The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Qiuyu Wang
- Jiangsu Health Vocational College, Nanjing, Jiangsu, China
| | - Zhang Min
- The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.,School of Psychology, Nanjing Normal University, Nanjing, Jiangsu, China
| | - Gang Liu
- The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.,Cognitive Behavioral Therapy Institute of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yuan Zhong
- School of Psychology, Nanjing Normal University, Nanjing, Jiangsu, China
| | - Ning Zhang
- The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.,Cognitive Behavioral Therapy Institute of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Chun Wang
- The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.,Cognitive Behavioral Therapy Institute of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Na Liu
- The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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Meddeb A, Berlin J, Laporte N, Wallinius M. Adverse childhood experiences do not moderate the association between aggressive antisocial behavior and general disinhibition in a forensic psychiatric inpatient sample. Front Psychol 2022; 13:1019246. [DOI: 10.3389/fpsyg.2022.1019246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 10/07/2022] [Indexed: 11/13/2022] Open
Abstract
Adverse childhood experiences (ACE) and high levels of disinhibition have been associated with a variety of negative outcomes such as aggressive antisocial behavior (AAB). However, forensic psychiatric populations remain an understudied group in this field of research. This study aimed to fill that gap by investigating associations between ACE, AAB, and disinhibition in a forensic psychiatric sample. Furthermore, we aimed to explore such findings by investigating whether ACE might have a moderating effect on the association between disinhibition and AAB. A sample of forensic psychiatric patients (n = 89) was recruited from a high-security forensic psychiatric facility in Sweden. All study variables were moderately to strongly related to each other, although we found no moderating effect of ACE. Post hoc analysis indicated that our ACE items had differential effects on AAB scores, with placement outside the family home, absent parents, and parental drug abuse producing the largest effect on AAB levels. Our findings are in line with previous research demonstrating a significant and robust relationship between ACE, AAB, and disinhibition. Forensic psychiatric populations are exposed to high levels of both self-reported and documented ACE. This calls for trauma-informed care and highlights the importance of considering ACE in risk assessment, preventive work, and policy making.
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Keulen-de Vos M, de Klerk A. Dutch forensic patients with and without intellectual disabilities: A comparison of demographic, offence, and diagnostic characteristics. RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 126:104255. [PMID: 35504124 DOI: 10.1016/j.ridd.2022.104255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 04/25/2022] [Accepted: 04/25/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Patients with an intellectual disability (ID) and offending histories constitute a challenging clinical group. The present study examined commonalities and differences in demographic, diagnostic and offence characteristics in patients with and without intellectual disabilities who were either convicted for violent or sexual offences and who resided in mandated care in the Netherlands. METHOD We compared 165 offenders with an ID to 249 offenders without an ID. We compared both groups by type of offence (i.e., sexual versus violent offence) using Mann-Whitney U-test or independent samples t-tests for continuous variables and Chi-square tests for categorical variables. RESULTS In general, forensic patients with an ID were younger at admission (U=357, z = -12.668, p < .001), had more prior convictions for violent offences (χ2(1)= 6.175, p = .013) and more prevalent diagnoses of substance abuse disorders (χ2(1)= 9.266, p = .002) than those without an ID. Similar results were found for patients with IDs with sexual offence histories. CONCLUSION A clear understanding of distinct characteristics of forensic patients with intellectual disabilities is crucial in understanding (sexual) violent behavior in this population as it mayassistclinicians in prioritizing interventionstrategies.
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Affiliation(s)
- Marije Keulen-de Vos
- Forensic Psychiatric Centre de Rooyse Wissel, Venray, The Netherlands; Radboud University, Faculty of Social Sciences, Nijmegen, The Netherlands.
| | - Anke de Klerk
- Forensic Psychiatric Centre de Rooyse Wissel, Venray, The Netherlands
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8
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Bianchini V, Paoletti G, Ortenzi R, Lagrotteria B, Roncone R, Cofini V, Nicolò G. The Prevalence of PTSD in a Forensic Psychiatric Setting: The Impact of Traumatic Lifetime Experiences. Front Psychiatry 2022; 13:843730. [PMID: 35573371 PMCID: PMC9091818 DOI: 10.3389/fpsyt.2022.843730] [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: 12/26/2021] [Accepted: 03/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background Several studies have identified traumatic history among forensic patients and its association with criminal behaviors and psychiatric diagnoses. Post-traumatic stress disorder (PTSD) is highly prevalent in forensic settings causing a serious deterioration of the primary psychiatric disorder. Aims Our study aims to evaluate the prevalence of PTSD and the role of traumatic experiences and abuse in the development of severe psychiatric disorders in a sample of psychiatric offenders. Methods Fifty-three patients admitted in Italian high intensity therapeutic facilities-the Residenze per l'Esecuzione delle Misure di Sicurezza (REMS)-were evaluated with the Trauma Experience Checklist (TEC) and the Millon Clinical Multiaxal Inventory (MCMI-III) to study lifetime traumatic memories and general psychopathology, respectively. Results Preliminary findings show that about 41% (N = 22) of psychiatric offenders were affected by PTSD, often not due to a single episode but to multiple lifetime traumas. Therefore, lifetime traumatic experiences and specifically sexual abuse are significant risk factors for the development of a personality disorder, which is present in the 38% (N = 20) of the sample. Conclusions The high PTSD prevalence and the strong association found between trauma and abuse with the development of a personality disorder emphasizes the importance of an early evaluation and intervention on traumatic experiences in this difficult population of psychiatric patients; in fact, the treatment of psychiatric offenders is actually vague and devoid of scientific evidence. Our results open up the perspective on the use of known and specific interventions for trauma, such as EMDR and Mindfulness.
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Affiliation(s)
- Valeria Bianchini
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
- Terzo Centro di Psicoterapia, Rome, Italy
| | - Giovanna Paoletti
- DSMDP Asl Roma 5, REMS Castore, Contrada Colle Cisterna, Subiaco, Italy
| | - Roberta Ortenzi
- DSMDP Asl Roma 5, REMS Castore, Contrada Colle Cisterna, Subiaco, Italy
- Scuola di Terapia Cognitiva—APC, Rome, Italy
| | - Brunella Lagrotteria
- Terzo Centro di Psicoterapia, Rome, Italy
- DSMDP Asl Roma 5, REMS Castore, Contrada Colle Cisterna, Subiaco, Italy
- Scuola di Psicoterapia Cognitiva—SPC, Rome, Italy
| | - Rita Roncone
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Vincenza Cofini
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Giuseppe Nicolò
- Terzo Centro di Psicoterapia, Rome, Italy
- DSMDP Asl Roma 5, REMS Castore, Contrada Colle Cisterna, Subiaco, Italy
- Scuola Italiana Cognitivismo Clinico—SICC, Rome, Italy
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Hodgins S. Could Expanding and Investing in First-Episode Psychosis Services Prevent Aggressive Behaviour and Violent Crime? Front Psychiatry 2022; 13:821760. [PMID: 35242064 PMCID: PMC8885584 DOI: 10.3389/fpsyt.2022.821760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/21/2022] [Indexed: 12/19/2022] Open
Abstract
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.
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Affiliation(s)
- Sheilagh Hodgins
- Département de Psychiatrie et Addictologie, Université de Montréal et Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada.,Haina Institute of Forensic Psychiatry, Haina, Germany
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Caruso R, Antenora F, Riba M, Belvederi Murri M, Biancosino B, Zerbinati L, Grassi L. Aggressive Behavior and Psychiatric Inpatients: a Narrative Review of the Literature with a Focus on the European Experience. Curr Psychiatry Rep 2021; 23:29. [PMID: 33825996 PMCID: PMC8026454 DOI: 10.1007/s11920-021-01233-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW We summarized peer-reviewed literature on aggressive episodes perpetrated by adult patients admitted to general hospital units, especially psychiatry or emergency services. We examined the main factors associated with aggressive behaviors in the hospital setting, with a special focus on the European experience. RECENT FINDINGS A number of variables, including individual, historical, and contextual variables, are significant risk factors for aggression among hospitalized people. Drug abuse can be considered a trans-dimensional variable which deserves particular attention. Although mental health disorders represent a significant component in the risk of aggression, there are many factors including drug abuse, past history of physically aggressive behavior, childhood abuse, social and cultural patterns, relational factors, and contextual variables that can increase the risk of overt aggressive behavior in the general hospital. This review highlights the need to undertake initiatives aimed to enhance understanding, prevention, and management of violence in general hospital settings across Europe.
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Affiliation(s)
- Rosangela Caruso
- Institute of Psychiatry, Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy. .,University Hospital Psychiatry Unit and Consultation-Liaison Psychiatry and Program on Psycho-Oncology and Psychiatry in Palliative Care, S. Anna University Hospital and Health Trust, Via Fossato di Mortara 64a, 44121, Ferrara, Italy.
| | - Fabio Antenora
- Institute of Psychiatry, Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Michelle Riba
- Department of Psychiatry, University of Michigan, Ann Arbor, MI USA ,University of Michigan Comprehensive Depression Center, Ann Arbor, MI USA ,Psycho-oncology Program, University of Michigan Rogel Cancer Center, Ann Arbor, MI USA ,Department of Psycho-oncology, Cancer and Molecular Medicine, University of Leicester, Leicester, UK
| | - Martino Belvederi Murri
- Institute of Psychiatry, Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy ,University Hospital Psychiatry Unit and Consultation-Liaison Psychiatry and Program on Psycho-Oncology and Psychiatry in Palliative Care, S. Anna University Hospital and Health Trust, Via Fossato di Mortara 64a, 44121 Ferrara, Italy
| | | | - Luigi Zerbinati
- Institute of Psychiatry, Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Luigi Grassi
- Institute of Psychiatry, Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy ,University Hospital Psychiatry Unit and Consultation-Liaison Psychiatry and Program on Psycho-Oncology and Psychiatry in Palliative Care, S. Anna University Hospital and Health Trust, Via Fossato di Mortara 64a, 44121 Ferrara, Italy
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11
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Bourgeois C, Lecomte T, McDuff P, Daigneault I. Mental health disorders as cooccuring and predictive factors of psychotic disorders in sexually abused children. CHILD ABUSE & NEGLECT 2021; 111:104819. [PMID: 33261843 DOI: 10.1016/j.chiabu.2020.104819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/10/2020] [Accepted: 11/09/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Little is known about the factors associated with psychosis in sexually abused children. Many factors have been associated with both sexual abuse and psychosis, and some mental health disorders have been identified as implied in the relationship between childhood trauma and psychosis. OBJECTIVES This study aims to identify factors cooccurring with psychotic disorders in sexually abused youth and to determine which predict the development of psychosis in this population. PARTICIPANTS AND SETTING Children with a corroborated report of sexual abuse (n = 882) at a Child Protection Agency (CPA) between 2000 and 2010 and whose health data could be retrieved from public health databases were selected for this study. METHODS A prospective matched-cohort design was used, with administrative databases from a CPA and a public health system. Logistic regressions were performed to determine which mental health diagnoses were associated with, and which predicted, psychotic disorders. RESULTS Logistic regressions revealed that personality disorders were significantly associated with psychotic disorders whereas substance misuse disorders and intellectual disability significantly predicted psychotic disorders. CONCLUSIONS Psychotic disorders and personality disorders appear concomitantly in sexually abused youth. Having received a substance misuse disorder diagnosis increases the risk of developing a psychotic disorder in sexually abused youth. Health professionals should be aware of those risk factors to help reduce the severity of youth sexual abuse consequences and, ultimately, prevent psychosis.
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Affiliation(s)
- Catherine Bourgeois
- Université de Montréal, Department of Psychology, 90 avenue Vincent d'Indy, Montreal, Quebec, H2V 2S9, Canada.
| | - Tania Lecomte
- Université de Montréal, Department of Psychology, 90 avenue Vincent d'Indy, Montreal, Quebec, H2V 2S9, Canada
| | - Pierre McDuff
- Université de Montréal, Department of Psychology, 90 avenue Vincent d'Indy, Montreal, Quebec, H2V 2S9, Canada
| | - Isabelle Daigneault
- Université de Montréal, Department of Psychology, 90 avenue Vincent d'Indy, Montreal, Quebec, H2V 2S9, Canada
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12
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Petrovic M, Injac Stevovic L. Intergeneration Transmission of Violence in Forensic Patients With a Diagnosis of Schizophrenia and Psychosis: Was Parental Alcoholic Abuse a Significant Factor? Front Psychiatry 2021; 12:765279. [PMID: 34925095 PMCID: PMC8675210 DOI: 10.3389/fpsyt.2021.765279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/02/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Child abuse during childhood and the presence of parental alcohol abuse increase the risk of developing mental illness in children, as well as the risk of violent behavior in adulthood. The association of these factors has not been sufficiently investigated when it comes to forensic mental patients. In this study, we examined the impact of traumatic events in childhood and the presence of mental illness and alcohol abuse of parents in subjects with psychosis and schizophrenia who committed serious crimes. Methods: One-hundred and forty-three respondents were included in the current study. Information on childhood abuse was collected by Childhood Trauma Questionnaire (CTQ). The sample included participants diagnosed with psychotic disorders and schizophrenia with a history of violent behavior (PSCH-V, n = 20), patients diagnosed with psychotic disorders and schizophrenia without a history of violent behavior (Non-V-PSCH, n = 51), and healthy control patients (HC, n = 72). Participants were diagnosed according to the ICD 10 classification system. MINI and CAINS scales were used to confirm the diagnosis. Data on sociodemographic and clinical characteristics were collected. Differences between groups in terms of traumatic events in childhood as well as parental alcohol abuse are presented and analyzed, using descriptive statistical values and nonparametric techniques of inferential statistics. Results: Statistically significant differences were obtained for total scores (χ2 = 28.522, p < 0.001) as well as for (1) major upheaval between the parents (χ2 = 20.739, p < 0.001), (2) being victim of violence-other than sexual (χ2 = 12.701, p < 0.01), and (3) other major upheaval that may have shaped life or personality significantly (χ2 = 30.920, p < 0.001). PSCH-V, compared to HC, had greater exposure to all of the three domains of childhood trauma (U = 396.500, 436.500, and 376.000, respectively; p < 0.001). Similar results were obtained when Non V-PSCH were compared with HC (U = 1,223.000, 1,535.000, and 999.000, respectively; p < 0.001). The results indicated statistically insignificant differences between PSCH-V and Non-V-PSCH in having a family history of mental illness. On the other hand, family history of mental illness was less present in HC compared to PSCH-V (χ2 = 24.238, p < 0.001) and Non V-PSCH (χ2 = 14.456, p < 0.001). The presence of parental alcohol abuse was predominantly present in the PSCH-V group (60%) while a significantly lower presence was found in the Non-V PSCH group (35%) and HC (5.5%). Conclusion: Both PSCH-V and Non-V-PSCH groups had a high degree of exposure to traumatic events in childhood compared to the HC. In PSCH-V, the presence of parental alcohol abuse compared to Non-V-PSCH was dominant. Mental illness coupled with a history of violent behavior represents a factor of polyvictimization, which may increase the likelihood of violent behavior of offspring.
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Affiliation(s)
- Milena Petrovic
- Medical Faculty University of Montenegro, Podgorica, Montenegro.,Clinical Center of Montenegro, Psychiatric Clinic, Podgorica, Montenegro
| | - Lidija Injac Stevovic
- Medical Faculty University of Montenegro, Podgorica, Montenegro.,Clinical Center of Montenegro, Psychiatric Clinic, Podgorica, Montenegro
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13
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Syed Sheriff R, Van Hooff M, Malhi GS, Grace B, McFarlane A. Childhood determinants of suicidality in men recently transitioned from regular military service. Aust N Z J Psychiatry 2020; 54:743-754. [PMID: 32536196 DOI: 10.1177/0004867420924742] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Rates of suicidality are higher in military than comparable civilian populations. The period of transition from regular military service may be a time of particular vulnerability. In order to best inform early intervention and prevention strategies, we sought to investigate the childhood determinants (trauma and disorder) of self-reported past-year suicidality (thoughts, plans or attempts) in a population of Australian Defence Force men who had recently (in the previous 5 years) transitioned from regular military service. METHODS We analysed self-report, and detailed interview, cross-sectional data to investigate the association between retrospectively reported past-year suicidality and childhood factors (disorder and trauma) and whether these relationships were independent of each other and adult-onset trauma and disorder. We utilised logistic regression techniques and generalised structural equation modelling. RESULTS The prevalence of suicidality in transitioned men was 21.6% (95% confidence interval [CI]: [19.9, 23.3]). Suicidality was associated with childhood-onset interpersonal trauma and anxiety and adult-onset anxiety and depression. Generalised structural equation modelling demonstrated that the pathway between childhood interpersonal trauma and suicidality was not fully mediated by childhood anxiety. Restricting the analyses to those previously deployed demonstrated that suicidality had a direct and significant association with childhood-onset factors (anxiety and interpersonal trauma) and adult-onset trauma (deployment and non-deployment related). CONCLUSION This study sheds light onto the significance of childhood factors (interpersonal trauma and anxiety) in a population undergoing transition that may revive pre-existing vulnerabilities. These findings have the potential to aid early intervention and prevention strategies in identifying those at risk prior to transition. These findings also imply that early interventions targeting anxiety and interventions to reduce social instability during the transition period may be useful in reducing suicidality during this time. Further prospective studies are needed to further explore these novel findings.
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Affiliation(s)
- Rebecca Syed Sheriff
- Discipline of Psychiatry, The University of Adelaide, Adelaide, SA, Australia.,Department of Psychiatry, University of Oxford, Oxford, UK.,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Miranda Van Hooff
- Discipline of Psychiatry, The University of Adelaide, Adelaide, SA, Australia
| | - Gin S Malhi
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, Australia
| | - Blair Grace
- Department of Education and Child Development, South Australia, SA, Australia
| | - Alexander McFarlane
- Discipline of Psychiatry, The University of Adelaide, Adelaide, SA, Australia
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14
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Fosse R, Eidhammer G, Selmer LE, Knutzen M, Bjørkly S. Strong Associations Between Childhood Victimization and Community Violence in Male Forensic Mental Health Patients. Front Psychiatry 2020; 11:628734. [PMID: 33633598 PMCID: PMC7901946 DOI: 10.3389/fpsyt.2020.628734] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/30/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Childhood abuse and neglect increase the risk of both mental disorders and violent behavior. Associations between child relational adversities and violent behavior have not been extensively investigated in forensic mental health settings. We asked whether the extent of child adversities predicts the extent of violence in the community in forensic mental health patients. Methods: We included 52 male patients at a medium security forensic mental health ward, with diagnoses of predominantly paranoid schizophrenia and other schizophrenia and psychotic disorders. Seventy-five percent had comorbid substance abuse. We extracted information on six types of child adversities based on clinicians' administrations of the Historical Clinical Risk Management 20 version 3 (HCR 20) scale and summary notes in electronic patient journals. These same sources were used to extract information on war trauma and interpersonal violence in the community. We established cumulative scales for exposure to number of types of child adversities and number of incidents of community violence. Results: Physical and emotional abuse, emotional and physical neglect, and bullying were associated with higher levels of community violence. We observed a linear, significant increase in the frequency of community violence with cumulative numbers of child adversity types. Conclusions: Cumulative exposure to child adversities may be associated with higher degrees of violence in forensic mental health patients, with the most violent patients having the most extensive exposures to adversities. An enhanced focus on child adversities in risk assessment and management of violence may be considered in forensic inpatient settings.
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Affiliation(s)
- Roar Fosse
- Division of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway
| | - Gunnar Eidhammer
- Division of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway.,Center for Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway
| | - Lars Erik Selmer
- Division of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway.,Center for Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway
| | - Maria Knutzen
- Center for Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway
| | - Stål Bjørkly
- Center for Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway.,Faculty of Health and Social Sciences, Molde University College, Molde, Norway
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15
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Engelstad KN, Rund BR, Lau B, Vaskinn A, Torgalsbøen AK. Increased prevalence of psychopathy and childhood trauma in homicide offenders with schizophrenia compared to nonviolent individuals with schizophrenia. Nord J Psychiatry 2019; 73:501-508. [PMID: 31443617 DOI: 10.1080/08039488.2019.1656777] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Purpose: Schizophrenia is associated with an increased homicide risk. Personality pathology, particularly antisocial personality disorder and psychopathic traits, has been associated with increased violence risk in schizophrenia. Childhood trauma, more specifically physical abuse, has been associated with violence risk in healthy populations and in individuals with mental illness. It is, however, unclear how childhood trauma relates to homicide in schizophrenia. This is, to our knowledge, the first study to concurrently examine personality pathology and childhood trauma in a group consisting solely of homicide offenders with schizophrenia (HOS). HOS is compared to nonviolent participants with the same diagnosis (non-HOS). Additionally, currently assessed demographical and clinical characteristics of a Norwegian sample of HOS are reported. Materials and methods: Two groups of participants with schizophrenia were recruited in collaboration with in and outpatient clinics across Norway, HOS (n= 26) and non-HOS (n= 28). Assessments of personality pathology and childhood trauma were conducted, and information about clinical and demographical characteristics was registered. Results: HOS participants had significantly higher psychopathy scores, and more frequently reported moderate to severe childhood physical abuse than non-HOS participants. When simultaneously added to a logistic regression model, only psychopathy uniquely contributed to explaining group membership. Conclusions: Psychopathy and physical abuse was more prevalent among HOS participants compared to non-HOS, but only psychopathy independently predicted homicidal status. These results confirm the importance of including an evaluation of psychopathic traits in violence risk assessments of individuals with schizophrenia.
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Affiliation(s)
| | - Bjørn Rishovd Rund
- Research Department, Vestre Viken Hospital Trust , Drammen , Norway.,Department of Psychology, University of Oslo , Oslo , Norway
| | - Bjørn Lau
- Department of Psychology, University of Oslo , Oslo , Norway.,Department of Research, Lovisenberg Hospital , Oslo , Norway
| | - Anja Vaskinn
- Norwegian Centre for Mental Disorders Research (NORMENT), Oslo University Hospital , Oslo , Norway.,Institute of Clinical Medicine, University of Oslo , Oslo , Norway
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16
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McKenna G, Jackson N, Browne C. Trauma history in a high secure male forensic inpatient population. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2019; 66:101475. [PMID: 31706394 DOI: 10.1016/j.ijlp.2019.101475] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/03/2019] [Accepted: 07/17/2019] [Indexed: 06/10/2023]
Abstract
There is an increasing focus on trauma within forensic services. This study aimed to investigate exposure to trauma among a high secure male forensic population. Based on the Childhood Trauma Questionnaire (CTQ) and the Trauma History Questionnaire (THQ) data capture sheets were developed. Patients' own offending behaviour was included as a source of potential trauma. Records for all patients placed within the hospital (n = 194) were reviewed. All patients had been exposed to a traumatic event over the lifespan, with 75% having been exposed to trauma during childhood. Sixty-five percent of patients had experienced more than one type of trauma during childhood; the mean number of trauma types experienced during this period being 2.31. In adulthood 63% had been exposed to one trauma type while 29% had been exposed to two or more trauma types. No significant difference was found between those with and those without childhood trauma histories on hospital variables including admission length, seclusion and incidents. The implications of these results in the context of adopting a trauma informed care approach to treatment in forensic settings are discussed, and recommendations for future clinical and research directions are made.
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Affiliation(s)
- Gráinne McKenna
- High Secure Psychological Services Ashworth Hospital, Mersey Care NHS Foundation Trust, Parkbourn, Maghull, Merseyside L31 1HW, UK.
| | - Neil Jackson
- High Secure Psychological Services Ashworth Hospital, Mersey Care NHS Foundation Trust, Parkbourn, Maghull, Merseyside L31 1HW, UK
| | - Claire Browne
- High Secure Psychological Services Ashworth Hospital, Mersey Care NHS Foundation Trust, Parkbourn, Maghull, Merseyside L31 1HW, UK
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17
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Scherer JN, Silvello D, Volpato VL, Roglio VS, Fara L, Ornell F, von Diemen L, Kessler FP, Pechansky F. Predictive factors associated with driving under the influence among Brazilian drug-using drivers. ACCIDENT; ANALYSIS AND PREVENTION 2019; 123:256-262. [PMID: 30553128 DOI: 10.1016/j.aap.2018.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 12/04/2018] [Accepted: 12/05/2018] [Indexed: 06/09/2023]
Abstract
The incidence of driving under the influence of psychoactive substances (DUI) and its recidivism can be curtailed by the proper identification of specific and predictive characteristics among drug users. In this sense, interpersonal violence (IV), psychiatric comorbidity and impulsivity seem to play an important role in DUI engagement according to previous studies. There are, however, limited data originated from low and middle income countries. In the present study, drug-using Brazilian drivers reporting DUI (n = 75) presented a higher prevalence of bipolar disorders (BD; DUI: 8% vs. non-DUI: 0%, p < 0.001), lower prevalence of obsessive-compulsive disorder (OCD; DUI: 0% vs. non-DUI: 12.6%, p < 0.001), and higher prevalence of childhood trauma (DUI: 65.3% vs. non-DUI: 46.8%, p = 0.022) than those not reporting DUI (n = 79). The evaluation of impulsivity though the Barratt Impulsivity Scale, which give impulsivity scores ranging from 30 to 120, showed higher impulsivity scores in the DUI group (80.4 ± 8) than in the non-DUI group (77.2 ± 10, p = 0.045). In general, subjects were young adults (mean age of 36 ± 9 years), Caucasians (58.4%), not married (61.0%), and with elementary schooling (40.3%) with no significant differences in demographic characteristics between drivers with and without DUI behavior. A multiple Poisson regression model showed that individuals reporting IV as perpetrators and history of childhood trauma were more likely to report DUI (PR: 1.66, 95%CI 1.22-2.7; PR: 1.57, 95%CI 1.02-2.42, respectively). The overlapping of violent situations (childhood trauma, IV and DUI) in some individuals presented here corroborates literature data suggesting that DUI can be an externalizing expression of a range of risky behavior, such as impulsiveness and aggressiveness. Moreover, while BD and higher impulsivity scores seem to act as risk factors for DUI, OCD was shown as a protective factor. These results corroborate the hypothesis that individuals with high risk for DUI could probably be identified by multidimensional assessment of cognitive, risky taking, and personality traits, which perhaps could facilitate the development of focused interventions.
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Affiliation(s)
- Juliana N Scherer
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Rua Professor Álvaro Alvim, 400, 90420-020, Porto Alegre, RS, Brazil.
| | - Daiane Silvello
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Rua Professor Álvaro Alvim, 400, 90420-020, Porto Alegre, RS, Brazil
| | - Vanessa L Volpato
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Rua Professor Álvaro Alvim, 400, 90420-020, Porto Alegre, RS, Brazil
| | - Vinícius S Roglio
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Rua Professor Álvaro Alvim, 400, 90420-020, Porto Alegre, RS, Brazil
| | - Letícia Fara
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Rua Professor Álvaro Alvim, 400, 90420-020, Porto Alegre, RS, Brazil
| | - Felipe Ornell
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Rua Professor Álvaro Alvim, 400, 90420-020, Porto Alegre, RS, Brazil
| | - Lisia von Diemen
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Rua Professor Álvaro Alvim, 400, 90420-020, Porto Alegre, RS, Brazil
| | - Felix Paim Kessler
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Rua Professor Álvaro Alvim, 400, 90420-020, Porto Alegre, RS, Brazil
| | - Flavio Pechansky
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Rua Professor Álvaro Alvim, 400, 90420-020, Porto Alegre, RS, Brazil
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18
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Lim E, Wynaden D, Heslop K. Changing practice using recovery-focused care in acute mental health settings to reduce aggression: A qualitative study. Int J Ment Health Nurs 2019; 28:237-246. [PMID: 30027634 DOI: 10.1111/inm.12524] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/27/2018] [Indexed: 01/15/2023]
Abstract
Consumer aggression is common in acute mental health settings and can result in direct or vicarious psychological or physical impacts for both consumers and health professionals. Using recovery-focused care, nurses can implement a range of strategies to reduce aggression and empower consumers to self-regulate their behaviour, when faced with challenging situations, such as admission to the acute care setting. Currently, there is limited literature to direct nurses in the use of recovery-focused care and how it can be used to reduce consumer aggression. Twenty-seven mental health nurses participated in this study. The constructivist grounded theory method guided data collection and analysis to identify categories that accurately described participants' experiences. Five categories emerged that described how nurses can implement recovery-focused care clinically to reduce the risk of consumer aggression: (i) identify the reason for the behaviour before responding; (ii) being sensitive to the consumer's trigger for aggression; (iii) focus on the consumer's strengths and support, not risks; (iv) being attentive to the consumer's needs; and (v) reconceptualize aggression as a learning opportunity. As the importance of promoting consumer recovery is now embedded in mental health policies internationally, nurses need to prioritize the application of recovery-focused care clinically. Further research to provide evidence-based outcomes supporting the use of recovery-focused care is needed.
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Affiliation(s)
- Eric Lim
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Dianne Wynaden
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Karen Heslop
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
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Jury A, Lai J, Tuason C, Koning A, Smith M, Boyd L, Swanson C, Fergusson D, Gruar A. People who experience seclusion in adult mental health inpatient services: An examination of health of the nation outcome scales scores. Int J Ment Health Nurs 2019; 28:199-208. [PMID: 30010239 DOI: 10.1111/inm.12521] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/25/2018] [Indexed: 11/27/2022]
Abstract
The Health of the Nation Outcomes Scales (HoNOS) provides an overview of a person's behaviour, impairment, clinical symptoms, and social functioning. This study investigated the profile of people who had been secluded in New Zealand's adult mental health inpatient services using 12 individual HoNOS ratings. Routinely collected clinical data were extracted from the Programme for the Integration of Mental Health Data (PRIMHD). This is the national data set for mental health and addiction services. A logistic regression model was fitted to the data which adjusted for age, sex, ethnicity, bed nights, compulsory treatment, and district health board. After adjustment, three HoNOS items significantly predicted the risk of seclusion: overactive, aggressive, disruptive, or agitated behaviour (adjusted OR = 4.82, 95% CI [3.88, 5.97], P < 0.001); problem drinking or drug-taking (adjusted OR = 1.51, 95% CI [1.25, 1.82], P < 0.001); and problems with hallucinations and delusions (adjusted OR = 1.33, 95% CI [1.09, 1.63], P = 0.006). In addition, two HoNOS items were protective for seclusion: nonaccidental self-injury (adjusted OR = 0.65, 95% CI [0.51, 0.83], P < 0.001) and depressed mood (adjusted OR = 0.58, 95% CI [0.47, 0.72], P < 0.001). Thus, responding effectively to agitation and/or aggression, substance use, and psychosis plays an important role in reducing the use of seclusion. Mental health nurses and other workers can reduce seclusion through early assessment, effective communication, de-escalation techniques, reduction tools, trauma-informed care, and consulting with consumers and whānau.
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Affiliation(s)
- Angela Jury
- Te Pou o te Whakaaro Nui, Auckland, New Zealand
| | | | | | | | - Mark Smith
- Te Pou o te Whakaaro Nui, Auckland, New Zealand
| | - Lois Boyd
- Te Pou o te Whakaaro Nui, Auckland, New Zealand
| | | | - David Fergusson
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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20
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Predicting time to recall in patients conditionally released from a secure forensic hospital: A survival analysis. Eur Psychiatry 2018; 49:1-8. [PMID: 29353176 DOI: 10.1016/j.eurpsy.2017.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 11/10/2017] [Accepted: 11/10/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The recall of conditionally discharged forensic patients in England is a formal order from the Ministry of Justice under the Mental Health Act (1983) which has the power to revoke conditional release and direct readmission to hospital. Recall has significant implications for the individual and for hospital services, but despite this, little is known about predictors of recall for forensic patients. METHODS We examined the rate of recall for 101 patients conditionally discharged from medium secure forensic inpatient services between 2007 and 2013. Demographic, clinical, and forensic factors were examined as possible predictors of time to recall using Cox regression survival techniques. RESULTS Conditionally discharged patients were followed for an average of 811 days, during which 45 (44.5%) were recalled to hospital. Younger age (HR 1.89; 95% CI 1.02-3.49; p = 0.04), non-white ethnicity (HR 3.44; 95% CI 1.45-8.13), substance abuse history (HR 2.52; 95% CI 1.17-5.43), early violence (HR 1.90; 95% CI 1.03-3.50), early childhood maladjustment (HR 1.92; 95% CI 1.01-3.68), treatment with a depot medication (HR 2.17; 95% CI 1.14-4.11), being known to mental health services (HR 3.44; 95% CI 1.06-11.16), and a psychiatric admission prior to the index admission (HR 2.44; 95% CI 1.08-5.52) were significantly associated with a shorter time to recall. Treatment with clozapine reduced the risk of recall to hospital (HR 0.40; 95% CI 0.20-0.79). CONCLUSIONS Time to recall can be predicted by a range of factors that are readily available to clinical teams. Further research is required to determine if targeted interventions can modify the likelihood or time to recall for conditionally released forensic patients.
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Hodgins S. Aggressive Behavior Among Persons With Schizophrenia and Those Who Are Developing Schizophrenia: Attempting to Understand the Limited Evidence on Causality. Schizophr Bull 2017; 43:1021-1026. [PMID: 28605537 PMCID: PMC5581895 DOI: 10.1093/schbul/sbx079] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
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.
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Affiliation(s)
- Sheilagh Hodgins
- Département de Psychiatrie, Institut Universitaire en Santé Mentale de Montréal, Université de Montréal, Montréal, Canada;,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,To whom correspondence should be addressed; Département de Psychiatrie, Institut Universitaire en Santé Mentale de Montréal, Université de Montréal, Centre de Recherché, 7331 Hochelaga, Montreal, Quebec H1N3V2, Canada; tel: +1-514-251-4000, fax: +1-514-251-4105, e-mail:
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Manchia M, Fanos V. Targeting aggression in severe mental illness: The predictive role of genetic, epigenetic, and metabolomic markers. Prog Neuropsychopharmacol Biol Psychiatry 2017; 77:32-41. [PMID: 28372995 DOI: 10.1016/j.pnpbp.2017.03.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 03/15/2017] [Accepted: 03/30/2017] [Indexed: 12/28/2022]
Abstract
Human aggression is a complex and widespread social behavior that is overrepresented in individuals affected by severe mental illness (SMI), such as schizophrenia (SCZ), bipolar disorder (BD), autism spectrum disorder (ASD), and attention-deficit/hyperactivity disorder (ADHD). A substantial proportion of the liability threshold for aggressive behavior is determined by genetic factors, and environmental moderators might precipitate the manifestation of this behavioral phenotype through modification of gene expression via the epigenetic machinery. These specific alterations in the genetic and epigenetic make-up of aggressive individuals might determine distinct biochemical signatures detectable through metabolomics. An additional pathophysiological component playing a role in aggressive behavior might be determined by alterations of gut microbiota. Here, we present a selective review of human data on genetic, epigenetic, and metabolomic markers of aggressive behavior in SMI, discussing also the available evidence on the role of microbiome alterations. Clinical implication of these evidences, as well as future perspectives, will be discussed.
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Affiliation(s)
- Mirko Manchia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Vassilios Fanos
- Department of Surgical Sciences, University of Cagliari and Neonatal Intensive Care Unit, Cagliari, Italy; Puericulture Institute and Neonatal Section, Azienda Ospedaliera Universitaria, Cagliari, Italy.
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23
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Stinson JD, Quinn MA, Levenson JS. The impact of trauma on the onset of mental health symptoms, aggression, and criminal behavior in an inpatient psychiatric sample. CHILD ABUSE & NEGLECT 2016; 61:13-22. [PMID: 27693854 DOI: 10.1016/j.chiabu.2016.09.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 08/29/2016] [Accepted: 09/16/2016] [Indexed: 06/06/2023]
Abstract
Experiences of trauma and maltreatment are frequent predictors of poor physical and mental health outcomes in adulthood. Existing literature also suggests an impact of developmental adversity on criminality and aggressive behavior, though little research exists describing the effects of cumulative adversity in forensic mental health samples. In the current study of 381 forensic mental health inpatients, rates of trauma, neglect, and parental substance abuse are reported in comparison with community norms. Cumulative adversity and the occurrence of foster care placement are examined via linear and logistic regression analyses in relation to age at first arrest, first psychiatric hospitalization, and onset of aggression, as well as history of suicide attempts and non-suicidal self-injury. Results revealed that experiences of developmental adversity were more common among participants than have been reported in community samples using the ACE survey, and that there were differential effects of gender on the prevalence of traumas experienced. Cumulative adversity scores were significantly associated with all outcomes, though the addition of foster care placement to the model significantly contributed to understanding outcomes, and in some cases, removed the effect of cumulative adversity. Implications and direction for future study are discussed.
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Affiliation(s)
- Jill D Stinson
- East Tennessee State University, Department of Psychology, United States.
| | - Megan A Quinn
- East Tennessee State University, Department of Biostatistics & Epidemiology, United States
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Childhood adversity and conduct disorder: A developmental pathway to violence in schizophrenia. Schizophr Res 2016; 172:54-9. [PMID: 26879586 DOI: 10.1016/j.schres.2016.01.047] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 01/14/2016] [Accepted: 01/25/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Both childhood adversity and conduct disorder are over-represented among adult patients with schizophrenia and have been proposed as significant factors that may increase the risk of violence. It is not known how childhood adversity and conduct disorder might interact to contribute towards an increased risk of violence in schizophrenia. This study aimed to explore the relationships between childhood adversity, conduct disorder and violence among men with schizophrenia. METHODS 54 male patients with schizophrenia from a range of inpatient and outpatient mental health services were assessed for exposure to a variety of childhood adversities, conduct disorder before the age of 15 and later violent behaviour in adulthood. RESULTS Exposure to domestic violence during childhood was associated with an increased propensity to violence in adulthood. Symptoms of conduct disorder were associated both with cumulative exposure to childhood adversities and with later propensity to violence. The cumulative number of childhood adversities was associated with adult propensity to violence. This association was significantly attenuated by inclusion of conduct disorder in the model. CONCLUSIONS This is the first study to demonstrate an association between childhood exposure to domestic violence and later violent behaviour in schizophrenia. Conduct disorder may mediate the association between cumulative childhood adversities and adult propensity to violence, indicating an indirect pathway. These results indicate a complex interplay between childhood adversity, conduct disorder and later violent behaviour in schizophrenia, and suggest that there may be shared aetiological risk factors on a common developmental pathway to violence.
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