Cognitive functions and recidivism of aggressive behavior in schizophrenic inpatients at Forensic Unit Clinic of Psychiatry in Kosovo

Intervening factors between risk of violence and aggressive behaviours among forensic inpatients: a scoping review

BACKGROUND

Risk of violence is closely associated with aggression propensity. However, there is a lack of research to explain the mechanisms behind this association, especially among the patients of forensic secure facilities. This review aimed to identify and synthesize the available literature concerning the intervening factors (mediating or moderating factors) in the relationship between the risk of violence and aggressive behavior in forensic secure facilities.

METHODS

Two electronic academic databases were searched: Scopus and Web of Science (WoS) using specific keywords as search terms derived from the PCC framework with no specific time limit. The search strategy was developed based on the JBI Manual for Evidence Synthesis and utilised the PRISMA-ScR guidelines. Data on the risk of violence, intervening factors, and aggressive behavior were extracted from the included studies. Further analysis was performed whereby similar data were grouped and synthesised together.

RESULTS

The initial search produced 342 studies. However, only nine studies fulfilled the inclusion criteria. The nine studies included 1,068 adult forensic inpatients from various psychiatric hospitals. Only mediation studies reported significant mechanisms of influence between the risk of violence and aggressive behavior. It is postulated that the human agency factor may be the underlying factor that influences a person's functioning and the subsequent series of events between the risk of violence and aggression.

CONCLUSIONS

In light of the paucity of evidence in this area, a generalised conclusion cannot be established. More studies are warranted to address the gaps before conclusive recommendations can be proposed to the relevant stakeholders.

Positive and negative syndrome scale in forensic patients with schizophrenia spectrum disorders: a systematic review and meta-analysis

Among forensic patients with schizophrenia spectrum disorders, the association between symptomatology and violence is still not entirely clear in literature, especially because symptoms shift both during the acute phase of the illness and after. The aims were to investigate the level of symptomatology in forensic patients and to evaluate if there are differences in the level of symptoms between forensic and non-forensic patients. According to PRISMA guidelines, a systematic search was performed in PubMed, Web of Science, and ProQuest, using the following key words: "forensic" AND "Positive and Negative Syndrome Scale" OR "PANSS". A total of 27 studies were included in the systematic review, while only 23 studies in the meta-analysis. The overall sample included a total of 1702 participants, most commonly male and inpatients in forensic settings. We found that studies with an entirely male sample had significantly lower Positive PANSS ratings than studies with mixed samples. Although both forensic and non-forensic patients were affected by mild psychopathological symptoms, forensic patients presented higher ratings in all four PANSS scales. This meta-analysis shows that forensic patients reported a mild level of symptomatology, as assessed with the PANSS, and therefore might be considered as patients in partial remission. Among patients with schizophrenia, the association between symptoms and violence is very complex: many factors might be considered as key mediators and thus should be taken into account to explain this association. Further studies are needed.Trial registration all materials and data can be found on the OSF framework: https://osf.io/5ceja (date of registration: 8 September 2021).

The Importance of Considering Alexithymia during Initial Stages of Intimate Partner Violence Interventions to Design Adjuvant Treatments

Empirical evidence supports that individuals with alexithymia might be prone to certain types of violence, such as intimate partner violence against women (IPVAW). Moreover, considering that alexithymia is directly involved in behavior regulation, problems due to identifying and regulating emotional states might be postulated as responsible, at least in part, for the success of psychotherapeutic treatments designed for decreasing the future risk of reoffending. Therefore, we assessed whether alexithymia was a good predictor of the discontinuation of treatment (dropout) and the risk of recidivism during the initial stages of intervention in a sample of men convicted of IPVAW perpetration (n = 118), while controlling for potential confounding variables (i.e., socio-demographic characteristics, impulsivity, and drug misuse). Our data demonstrate that high alexithymic traits lead to dropout and a high risk of recidivism during the initial stages of treatment, remaining significant even after including potential confounding variables. Even though impulsivity and drug misuse increase the amount of explained variance, none of them moderates the association of alexithymia with dropout and/or reoffending. It should be noted that this study identified alexithymia as a direct modulator of violence due to its effects on discontinuing IPVAW treatment during initial stages. Therefore, as we gain knowledge analyzing the relationships between previously mentioned factors, it could be applied to develop valid screening methods along with strengthening current rehabilitation programs and designing adjuvant treatments to increase their effectiveness.

Acceptability of Intimate Partner Violence among Male Offenders: The Role of Set-Shifting and Emotion Decoding Dysfunctions as Cognitive Risk Factors

Attitudes towards the acceptability of intimate partner violence against women (IPVAW) contribute to an increased risk of IPVAW perpetration, and these attitudes are common among IPVAW offenders. Research suggests that IPVAW offenders present cognitive deficits related to information processing. Little is known, however, about how these deficits are related to the acceptability of IPVAW. The main aim of this study was to explore the relationship between specific cognitive deficits (i.e., deficits in attention switching, set-shifting, and emotion decoding abilities) and the acceptability of IPVAW in a sample of 84 IPVAW offenders. Results revealed that IPVAW offenders with deficits in attention switching, set-shifting, and emotion decoding abilities demonstrated greater acceptability of IPVAW, and these relationships remained significant after controlling for socio-demographic variables (i.e., age and educational level) and drug consumption. These results highlight the role of cognitive processes in maintaining attitudes of acceptability of IPVAW. Thus, the findings may guide professionals in developing specific intervention programs focused on improving cognitive abilities, in order to reduce the acceptability of IPVAW.

Alexithymic traits are closely related to impulsivity and cognitive and empathic dysfunctions in intimate partner violence perpetrators: New targets for intervention

Clinical psychologists are interested in studying factors that interfere with the behavioral regulation of perpetrators of intimate partner violence against women (IPVAW), as well as the way these factors affect the risk of future recidivism after interventions that are designed for them are completed. Although several variables have been proposed as risk factors for IPVAW, the role of alexithymia and its relationships with other cognitive and empathic variables in IPVAW perpetrators has been neglected. Thus, the main aim of this study was to compare the alexithymic and cognitive and empathic traits in a carefully selected sample of IPVAW perpetrators (n = 47; mean age = 39) with a control group matched on sociodemographic characteristics (n = 41; mean age = 42). Moreover, we also aimed to study whether alexithymic traits are related to cognitive and empathic alterations in IPVAW perpetrators. Compared to controls, IPVAW perpetrators had higher alexithymic and self-reported impulsivity traits and worse attention and executive functioning (e.g., verbal fluency and cognitive flexibility) performance than controls. Moreover, they also presented greater personal distress, compared to controls. Notably, we observed that higher alexithymia was associated with high self-reported impulsivity, worse cognitive and empathic performance in both groups. Our study identifies different cognitive targets for specific neuropsychological rehabilitation interventions designed to prevent violence recidivism in the long term through their effects on emotional information processing and behavioral regulation.