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Kilic-Demir B, Kizilpinar SC, Polat S. The violence profile of male mentally disordered offenders in a high secure unit in Turkiye. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2024; 94:101983. [PMID: 38537541 DOI: 10.1016/j.ijlp.2024.101983] [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: 06/26/2023] [Revised: 02/13/2024] [Accepted: 03/15/2024] [Indexed: 06/15/2024]
Abstract
Our knowledge of the severity and reoffending is limited for mentally disordered offenders, and studies generally evaluate without separation between different diagnostic groups. It was aimed to determine the general profile of mentally disordered offenders who are inpatients in a high secure psychiatry unit from Turkiye and to evaluate the factors associated with violence profiles among different diagnostic groups. According to the results the schizophrenia patients committed the most severe crimes, and intellectual disability patients had some different features from schizophrenia and bipolar disorder patients. History of substance misuse in the intellectual disability group (p = 0,045) and comorbid antisocial personality disorder in the bipolar disorder group (p = 0,015) were associated with increased crime severity. Substance misuse history, history of substance use during the crime, and the existence of comorbid antisocial personality disorder were associated with increased offenses in each of the three diagnosis groups. Living alone (p = 0,004) and having a suicide history (p= 0,052) were associated with the high number of offenses in the schizophrenia group. This study is the first study that compares three diagnostic groups to involve a large patient group. We believe that clinicians must evaluate these parameters for the violence risk assessment of patients.
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Affiliation(s)
- Baris Kilic-Demir
- Department of Psychiatry, Adana City Research and Training Hospital, Adana, Turkiye
| | | | - Selim Polat
- Department of Psychiatry, Adana City Research and Training Hospital, Adana, Turkiye
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Murphy M, Carrión RE, Rubio J, Malhotra AK. Peak alpha frequency and electroencephalographic microstates are correlated with aggression in schizophrenia. J Psychiatr Res 2024; 175:60-67. [PMID: 38704982 DOI: 10.1016/j.jpsychires.2024.04.051] [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: 02/09/2024] [Revised: 03/28/2024] [Accepted: 04/25/2024] [Indexed: 05/07/2024]
Abstract
Large scale retrospective studies have shown an association between schizophrenia and risk of violence. Overall, this increase in risk is small and does not justify or support stigmatizing public perceptions or media depictions of people with schizophrenia. Nonetheless, in some situations, some symptoms of schizophrenia can increase the risk of violent behavior. Prediction of this behavior would allow high impact preventive interventions. However, to date the neurobiological correlates of violent behavior in schizophrenia are not well understood, precluding the development of prognostic biomarkers. We used electroencephalography to measure alpha activity and microstates from 31 patients with schizophrenia and 18 age matched controls. Participants also completed multiple assessments of current aggressive tendencies and their lifetime history of aggressive acts. We found that individual alpha peak frequency was negatively correlated with aggression scores in both patients and controls (largest Spearman's r = -0.45). Furthermore, this result could be replicated in data taken from a single frontal channel suggesting that this may be possible to obtain in routine clinical settings (largest Spearman's r = -0.40). We also found that transitions between microstates corresponding to auditory and visual networks were inversely correlated with aggression scores. Finally, we found that, within patients, aggression was correlated with the degree of randomness between microstate transitions. This suggests that aggression is related to inappropriate switching between large scale brain networks and subsequent failure to appropriately integrate complicated environmental and internal stimuli. By elucidating some of the electrophysiological correlates of aggression, these data facilitate the development of prognostic biomarkers.
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Affiliation(s)
- Michael Murphy
- McLean Hospital, Belmont, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Ricardo E Carrión
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA; Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Northwell, New Hyde Park, NY, USA
| | - Jose Rubio
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA; Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Northwell, New Hyde Park, NY, USA
| | - Anil K Malhotra
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA; Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Northwell, New Hyde Park, NY, USA
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Machetanz L, Hofmann AB, Möhrke J, Kirchebner J. Offenders and non-offenders with schizophrenia spectrum disorders: the crime-preventive potential of sufficient embedment in the mental healthcare and support system. Front Psychiatry 2023; 14:1231851. [PMID: 37711423 PMCID: PMC10498463 DOI: 10.3389/fpsyt.2023.1231851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/04/2023] [Indexed: 09/16/2023] Open
Abstract
Background Suffering from schizophrenia spectrum disorder (SSD) has been well-established as a risk factor for offending. However, the majority of patients with an SSD do not show aggressive or criminal behavior. Yet, there is little research on clinical key features distinguishing offender from non-offender patients. Previous results point to poorer impulse control, higher levels of excitement, tension, and hostility, and worse overall cognitive functioning in offender populations. This study aimed to detect the most indicative distinguishing clinical features between forensic and general psychiatric patients with SSD based on the course of illness and the referenced hospitalization in order to facilitate a better understanding of the relationship between violent and non-violent offenses and SSD. Methods Our study population consisted of forensic psychiatric patients (FPPs) with a diagnosis of F2x (ICD-10) or 295.x (ICD-9) and a control group of general psychiatric patients (GPPs) with the same diagnosis, totaling 740 patients. Patients were evaluated regarding their medical (and, if applicable, criminal) history and the referenced psychiatric hospitalization. Supervised machine learning (ML) was used to exploratively evaluate predictor variables and their interplay and rank them in accordance with their discriminative power. Results Out of 194 possible predictor variables, the following 6 turned out to have the highest influence on the model: olanzapine equivalent at discharge from the referenced hospitalization, a history of antipsychotic prescription, a history of antidepressant, benzodiazepine or mood stabilizer prescription, medication compliance, outpatient treatment(s) in the past, and the necessity of compulsory measures. Out of the seven algorithms applied, gradient boosting emerged as the most suitable, with an AUC of 0.86 and a balanced accuracy of 77.5%. Discussion Our study aimed to identify the most influential illness-related predictors, distinguishing between FPP and GPP with SSD, thus shedding light on key differences between the two groups. To our knowledge, this is the first study to compare a homogenous sample of FPP and GPP with SSD regarding their symptom severity and course of illness using highly sophisticated statistical approaches with the possibility of evaluating the interplay of all factors at play.
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Affiliation(s)
- Lena Machetanz
- Department of Forensic Psychiatry, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Andreas B. Hofmann
- Department of Psychiatry, Psychotherapy, and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Jan Möhrke
- Department of Forensic Psychiatry, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Johannes Kirchebner
- Department of Forensic Psychiatry, University Hospital of Psychiatry Zurich, Zurich, Switzerland
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Bo S, Sharp C, Lind M, Simonsen S, Bateman A. Mentalizing mediates the relationship between psychopathy and premeditated criminal offending in schizophrenia: a 6-year follow-up study. Nord J Psychiatry 2023; 77:547-559. [PMID: 36897045 DOI: 10.1080/08039488.2023.2186483] [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] [Received: 11/11/2022] [Revised: 02/09/2023] [Accepted: 02/23/2023] [Indexed: 03/11/2023]
Abstract
PURPOSE Research has shown that schizophrenia augments the risk for criminal behaviour and variables both defining- and related to schizophrenia, increase criminal offending. Premeditated criminal offending is considered a severe form of criminal offending, however, very little is known about what predicts future premeditated criminal offending in schizophrenia. METHOD AND MATERIALS In this 6-year follow-up study we explored which factors underlie future premeditated criminal behaviour in a sample of patients diagnosed with schizophrenia (N = 116). We also investigated if a specific mentalizing profile underlie part of the variance of premeditated criminal offending. RESULTS Results showed that psychopathy underlie future premeditated crime in schizophrenia, and that a specific mentalizing profile, comprised of a dysfunctional emotional and intact cognitive mentalizing profile in relation to others, mediated parts of the relation between psychopathy and premeditated criminal offending. Finally, our results indicated that patients with schizophrenia with a specific mentalizing profile (see above) engaged in premeditated criminal behaviour earlier during the 6-year follow-up period compared to patients with other mentalizing profiles. CONCLUSIONS Our findings suggest that mentalization should carefully be inspected in patients with schizophrenia in relation to future premeditated offending.
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Affiliation(s)
- Sune Bo
- Department of Psychology, University of Copenhagen, DK and Department of Psychiatry, Denmark
| | - Carla Sharp
- Department of Psychology, University of Houston, USA
| | - Majse Lind
- Department of Psychology, University of Aalborg, Denmark
| | - Sebastian Simonsen
- Department of Psychology, University of Copenhagen, and Stolpegaard Psychotherapy Centre, Denmark
| | - Anthony Bateman
- Psychoanalysis Unit, University College London, United Kingdom
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van Beek J, Meijers J, Scherder EJA, Harte JM. Aggressive Incidents by Incarcerated People With Psychiatric Illness and Their Relationship With Psychiatric Symptoms. JOURNAL OF FORENSIC NURSING 2023; 19:E30-E38. [PMID: 37590946 DOI: 10.1097/jfn.0000000000000424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
AIM A prospective design was used to investigate the relationship of current psychiatric symptoms of incarcerated people with serious mental illness (SMI) and aggressive behavior on a penitentiary ward for crisis intervention. METHODS One hundred sixty detainees with SMI, detained in a high-security penitentiary psychiatric facility, were screened every 2 weeks with the Brief Psychiatric Rating Scale-Extended (BPRS-E) by trained clinicians, to ensure that the data on psychiatric symptoms were up-to-date. Aggressive behavior was registered with the Staff Observation Aggression Scale-Revised. A binary logistic regression analysis was performed to examine the relationships between factor scores of the BPRS-E and aggressive behavior. RESULTS Significant relationships between the BPRS-E factor hostility, antisocial traits, and aggressive incidents were found, but not between the positive symptoms or manic factor scores and aggressive incidents. DISCUSSION Symptoms of SMI measured with the BPRS-E did not help to explain the occurrence of aggressive behavior. This is not in line with what is commonly found. The implication is that it can be expected that this population will display aggressive behavior but that symptoms do not help in predicting when this will occur. In addition, hostility and antisocial traits were related to aggressive behavior. For this specific population, an interactional approach might be more effective in the management of aggression than treatment of symptoms of SMI.
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Affiliation(s)
| | | | - Erik J A Scherder
- Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam
| | - Joke M Harte
- Department of Criminal Law and Criminology, Faculty of Law, Vrije Universiteit Amsterdam
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Wolf V, Mayer J, Steiner I, Franke I, Klein V, Streb J, Dudeck M. Risk factors for violence among female forensic inpatients with schizophrenia. Front Psychiatry 2023; 14:1203824. [PMID: 37457783 PMCID: PMC10347379 DOI: 10.3389/fpsyt.2023.1203824] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/13/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction Schizophrenia is associated with a heightened risk of violent behavior. However, conclusions on the nature of this relationship remain inconclusive. Equally, the empirical evidence on female patients with schizophrenia spectrum disorders (SSD) is strongly underrepresented. Methods For this purpose, the first aim of the present retrospective follow-up study was to determine the risk factors of violence in a sample of 99 female SSD patients discharged from forensic psychiatric treatment between 2001 and 2017, using three different measures of violence at varying time points (i.e., violent index offense, inpatient violence, and violent recidivism). Potential risk factors were retrieved from the relevant literature on SSD as well as two violence risk assessment instruments (i.e., HCR-20 V3, FAM). Further, we aimed to assess the predictive validity of the HCR-20 V3 in terms of violent recidivism and evaluate the incremental validity of the FAM as a supplementary gender-responsive assessment. Results The given results indicate strong heterogeneity between the assessed violence groups in terms of risk factors. Particularly, violence during the index offense was related to psychotic symptoms while inpatient violence was associated with affective and behavioral instability as well as violent ideation/intent, psychotic symptoms, and non-responsiveness to treatment. Lastly, violent recidivism was related to non-compliance, cognitive instability, lack of insight, childhood antisocial behavior, and poverty. Further, the application of the HCR-20 V3 resulted in moderate predictive accuracy (AUC = 0.695), while the supplementary assessment of the FAM did not add any incremental validity. Discussion This article provides important insights into the risk factors of violence among female SSD patients while highlighting the importance of differentiating between various forms of violence. Equally, it substitutes the existing evidence on violence risk assessment in female offenders with SSD.
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Affiliation(s)
- Viviane Wolf
- Department of Psychiatry and Psychotherapy, Medical Faculty, LVR-Clinic Duesseldorf, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
- Department of Forensic Psychiatry and Psychotherapy, kbo-Isar-Amper-Clinic Taufkirchen (Vils), Taufkirchen (Vils), Germany
| | - Juliane Mayer
- Department of Forensic Psychiatry and Psychotherapy, kbo-Isar-Amper-Clinic Taufkirchen (Vils), Taufkirchen (Vils), Germany
| | - Ivonne Steiner
- Department of Forensic Psychiatry and Psychotherapy, kbo-Isar-Amper-Clinic Taufkirchen (Vils), Taufkirchen (Vils), Germany
| | - Irina Franke
- Psychiatric Services of Grisons, Chur, Switzerland
- Department of Forensic Psychiatry and Psychotherapy, Ulm University, Guenzburg, Germany
| | - Verena Klein
- Department of Forensic Psychiatry and Psychotherapy, kbo-Isar-Amper-Clinic Taufkirchen (Vils), Taufkirchen (Vils), Germany
| | - Judith Streb
- Department of Forensic Psychiatry and Psychotherapy, Ulm University, Guenzburg, Germany
| | - Manuela Dudeck
- Department of Forensic Psychiatry and Psychotherapy, Ulm University, Guenzburg, Germany
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Omelchenko MA, Zinkevich AS, Vares AY. [Impulsivity and aggression in patients at risk for schizophrenia at the stage of remission after the first depressive episode]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:83-92. [PMID: 38147387 DOI: 10.17116/jnevro202312312183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Abstract
OBJECTIVE To study the phenomenon of impulsivity, its components and aggression in patients at risk for schizophrenia at the stage of remission after the first depressive episode. MATERIAL AND METHODS Forty-eight male patients (mean age 19.4±2.9 years) with the first depressive episode (ICD-10 F32.1, F32.2) with attenuated positive, negative and/or disorganized symptoms were examined. According to the severity of impulsivity, the patients were divided into the clinical group (n=26) with pathological impulsivity and the comparison group (n=27) without it. The control group consisted of 41 mentally healthy young men, students of higher education of 1-3 courses, (mean age 19.7±1.6 years). HDRS, SOPS, SANS, Barratt Impulsiveness Scale (BIS-11) and Buss Perry Aggression Questionnaire (BPAQ) were used. Statistical analysis was carried out using the Statistica 12 software. RESULTS The differences between the clinical group and the comparison group were determined by the total score of the subscale of general symptoms of SOPS at admission (53 [41.75; 56] and 45.5 [41.75; 51.25], respectively) (U=187.5; p=0.037) and at discharge (28 [19; 37] and 25 [17.75; 29.25] points respectively) (U=166.5; p=0.012), according to the total HDRS score at admission (35 [31; 38] and 29 [26; 34.25]) (U=191.0; p=0.046). In the clinical group, the motor component of impulsivity and the factor of general impulsivity on the BIS-11 correlated with the severity of aggression on the BPAQ (r=0.395, p<0.05 and r=0.635, p<0.05, respectively). Significant differences were revealed in the clinical group depending on the presence of negative symptoms on the corresponding SOPS subscale according to the total BPAQ score (p=0.01). Correlation analysis showed numerous connections: positive between the total aggressiveness score and the duration of depression (p<0.05), negative between the factors of self-control, consistency, attention, and total scores on the SANS and SOPS (p<0.05). CONCLUSION We identify the differences in the structure of impulsivity in patients at risk of developing schizophrenia at the stage of remission after the first depressive state, the comparison group and the control group, as well as the relationship of impulsivity factors with individual clusters of psychopathological disorders.
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Affiliation(s)
| | | | - A Y Vares
- Lomonosov Moscow State Univesity, Moscow, Russia
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Gottfried ED, Mulay AL, Schenk AM, Vitacco MJ. MMPI-2-RF Differences Between Violent Offending and Institutional Violence Among Incarcerated Women. VIOLENCE AND VICTIMS 2022; 37:497-514. [PMID: 35705444 DOI: 10.1891/vv-2021-0065] [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: 06/15/2023]
Abstract
The examination of violence perpetrated by female offenders remains an understudied topic, as research typically focuses on male offender samples. As such, it remains unclear what personality characteristics may be associated with the perpetration of violence among female offenders. This study sought to examine the relationship between personality characteristics, as assessed by the MMPI-2-RF, and engagement in violence, within a sample of 228 incarcerated women. Results indicated that women serving time for a violent offense obtained higher mean scores on MMPI-2-RF scales related to underreporting, atypical thoughts/experiences, and paranoia. Women who obtained disciplinary reports for violence within the institution obtained higher mean scores on MMPI-2-RF scales related to behavior/externalizing dysfunction, overactivation, and aggression. Taken together, violence was most strongly associated with the MMPI-2-RF scales related to paranoia and atypical thoughts/experiences (e.g., THD, PSYC-r). This study provides new data on the viability of the MMPI-2-RF to provide critical insights into violent and aggression behavior in female inmates, an understudied population and demonstrate the instrument's efficacy in assessing characteristics associated with violent behavior.
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Affiliation(s)
- Emily D Gottfried
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, Community and Public Safety Psychiatry Division
| | - Abby L Mulay
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, Community and Public Safety Psychiatry Division
| | | | - Michael J Vitacco
- Institute of Public and Preventive Heath, Department of Psychiatry and Health Behavior, Augusta University
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Sen P, Adewusi D, Blakemore AI, Kumari V. How do lipids influence risk of violence, self-harm and suicidality in people with psychosis? A systematic review. Aust N Z J Psychiatry 2022; 56:451-488. [PMID: 34240626 PMCID: PMC9036157 DOI: 10.1177/00048674211025608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Low cholesterol has been linked with violent and suicidal behaviour in people with schizophrenia. This association, if consistently present, may be a promising biological marker that could assist clinicians in decision making regarding risk and treatment. We conducted a systematic review to assess whether there is a reliable association between lipid profile (total cholesterol, high- and low-density lipoprotein cholesterol, and triglycerides) and aggression, self-harm or suicide in people with schizophrenia, and whether effects are similar in males and females. METHOD Relevant databases were searched to identify primary research studies (up to November 2020) that (1) involved adults (some samples also included 16- to 18-year olds) with a confirmed diagnosis of schizophrenia, schizoaffective disorder or psychosis; and (2) included a standardised assessment of verbal aggression, physical aggression against objects, physical aggression against self (including suicide) or others. The search yielded 23 studies eligible for inclusion following a quality appraisal. RESULTS Suicidality was the most commonly assessed subtype of aggression (20 studies). For suicidality, about half the studies, including the study with the largest sample size, found a link with total cholesterol. An association between low total cholesterol and violence towards others was found in six of nine studies that investigated this. The evidence for a link with violence was the strongest for total cholesterol, followed by low-density lipoprotein cholesterol and high-density lipoprotein cholesterol, and the weakest for triglycerides. Only a few studies investigated sex differences and yielded mixed evidence. Studies focussed on self-harm as well as involving females in forensic settings were lacking. CONCLUSION There is encouraging evidence of an association between low total cholesterol and aggression towards others as well as suicidality in schizophrenia. Future studies should systematically explore this association in people with schizophrenia who have a significant history of violence, suicidality and self-harm, both inpatients and community, and also investigate underlying mechanisms.
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Affiliation(s)
- Piyal Sen
- Department of Life Sciences, Centre for Cognitive Neuroscience, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK,GKT School of Medicine, Faculty of Life Sciences & Medicine, King’s College London, London, UK
| | - Danielle Adewusi
- GKT School of Medicine, Faculty of Life Sciences & Medicine, King’s College London, London, UK
| | - Alexandra I Blakemore
- Department of Life Sciences, Centre for Cognitive Neuroscience, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK,Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Veena Kumari
- Department of Life Sciences, Centre for Cognitive Neuroscience, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK,Veena Kumari, Department of Life Sciences, and Centre for Cognitive Neuroscience, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge UB8 3PH, UK.
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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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Lamberti JS, Katsetos V, Jacobowitz DB, Weisman RL. Psychosis, Mania and Criminal Recidivism: Associations and Implications for Prevention. Harv Rev Psychiatry 2021; 28:179-202. [PMID: 32251070 DOI: 10.1097/hrp.0000000000000251] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
People with mental illness are overrepresented throughout the criminal justice system, including jail, prison, probation, and parole populations. Yet much disagreement remains about why this problem exists and how best to address it. This article specifically examines empirical evidence regarding the question of whether psychosis and mania are associated with criminal recidivism, and whether this association is predictive or causal in nature. Review of the current literature suggests that psychotic and manic symptoms are associated with increased likelihood of arrest and incarceration. In addition, current evidence shows that pharmacotherapy can reduce criminal recidivism among justice-involved adults with psychosis or mania. However, the extent to which the association between psychosis, mania, and criminal justice system involvement is causal remains uncertain. Also, the literature suggests that most crimes committed by people with schizophrenia spectrum disorders or bipolar I disorder may be driven by factors other than their psychotic or manic symptoms. These established "criminogenic needs" are more common among people with severe mental disorders than in the general population. For optimal prevention, those who serve justice-involved adults with psychosis or mania in community settings should consider addressing the full range of factors that potentially drive their criminal justice system involvement.
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Affiliation(s)
- J Steven Lamberti
- From the Department of Psychiatry, University of Rochester Medical Center, Rochester, NY
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12
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Vaskinn A, Engelstad KN, Torgalsbøen AK, Rund BR. Childhood trauma, social cognition and schizophrenia: Specific association between physical neglect and cognitive theory of mind in homicide offenders. Psychiatry Res 2021; 303:114093. [PMID: 34247060 DOI: 10.1016/j.psychres.2021.114093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 11/19/2022]
Abstract
Schizophrenia is associated with a small, but increased risk of violent behavior, including homicide. Violent individuals with schizophrenia have elevated rates of childhood trauma and substantial social cognitive impairments. The aim of this study was to examine if childhood trauma is related to social cognition in homicide offenders with schizophrenia. We recruited 26 individuals with schizophrenia sentenced to compulsory mental care for homicide/attempted homicide and 28 non-violent schizophrenia controls. They filled out the Childhood Trauma Questionnaire (CTQ), providing scores for physical abuse, sexual abuse, emotional abuse, physical neglect and emotional neglect. Social cognition was assessed with two measures of emotion processing (Emotion in Biological Motion, Pictures of Facial Affect) and two theory of mind (ToM) tests (Hinting Task, Movie for the Assessment of Social Cognition: MASC). Spearman's rho correlation coefficients were computed, and significant results followed up with partial correlation analyses controlling for IQ. Three associations were statistically significant, all in the homicide group; between CTQ physical neglect and cognitive ToM assessed with Hinting Task and with MASC, and between CTQ emotional neglect and Hinting Task. Only the first remained significant after controlling for IQ, indicating a specific association between physical neglect and cognitive ToM in homicide offenders with schizophrenia.
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Affiliation(s)
- Anja Vaskinn
- Centre for Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway; Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | | | | | - Bjørn Rishovd Rund
- Research Department, Vestre Viken Hospital Trust, Drammen, Norway; Department of Psychology, University of Oslo, Oslo, Norway
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Grose-Fifer J, Vidals D. Mental health stigma and emotional face processing: An ERP study. Soc Neurosci 2021; 16:573-583. [PMID: 34445931 DOI: 10.1080/17470919.2021.1973556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study takes the first step toward developing an event-related potential (ERP) measure of bias toward people with mental illnesses. We recorded participants' EEGs while they viewed happy and angry faces; they were told half of the people in the photos were mentally healthy while the other half had a diagnosis of schizophrenia, which was indicated by the color of the frame around each face. Afterward, participants rated how dangerous each face looked to them. Participants rated faces with the schizophrenia designation as more dangerous than those designated as mentally healthy. There were significant interactions between facial expression and mental health label for both the early N170 and later P3 amplitudes. Angry expressions elicited larger N170s than happy ones, but only for faces with the schizophrenia label. Thus, angry faces with the schizophrenia designation appeared to be particularly salient and automatically grabbed our participants' attention, at least initially. In contrast, happy faces with the schizophrenia label elicited larger P3s than those with the mentally healthy designation. This finding suggests that later attentional processes were recruited more when someone with a diagnosis of schizophrenia looked happy, perhaps indicating that participants found this surprising.
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Affiliation(s)
- Jillian Grose-Fifer
- Department of Psychology , John Jay College of Criminal Justice, City University of New York, New York, NY, USA.,Department of Psychology, The Graduate Center, City University of New York, New York, Ny, USA
| | - Denice Vidals
- Department of Psychology , John Jay College of Criminal Justice, City University of New York, New York, NY, USA
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14
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Green B, Steele ML, Davidson F, Neillie D. Contact with mental health services in the 12-month period before offending in a cohort of forensic order patients. PSYCHIATRY, PSYCHOLOGY, AND LAW : AN INTERDISCIPLINARY JOURNAL OF THE AUSTRALIAN AND NEW ZEALAND ASSOCIATION OF PSYCHIATRY, PSYCHOLOGY AND LAW 2021; 28:934-945. [PMID: 35694645 PMCID: PMC9176357 DOI: 10.1080/13218719.2021.1894264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
There has been limited research examining the details of mental health service contact in the pre-offending period. A retrospective case-note study of the complete cohort of people found not criminally responsible or permanently unfit for trial in Queensland, Australia, was conducted. An electronic clinical database search for seven treatment event types in the 12-months pre-offence was conducted. Of the 123 eligible patients, half were recorded as having experienced at least one treatment event. There was a statistically significant increase in the number of patients experiencing a treatment-related event per month over this 12-month pre-offence period (increase of ∼1.4 patients per month, p < .001). The findings highlight the need for appropriate weight to be placed on both longitudinal and recent factors when undertaking routine clinical review or mental health assessment, or considering changes to a patient's diagnosis and treatment plan. Screening in custody and early intervention are also indicated to ensure appropriate treatment.
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Affiliation(s)
- Bob Green
- Statewide Team, Queensland Forensic Mental Health Service, Brisbane, QLD, Australia
| | - Megan L. Steele
- Forensic Mental Health Group, Queensland Centre for Mental Health Research, Wacol, QLD, Australia
| | - Fiona Davidson
- Statewide Team, Queensland Forensic Mental Health Service, Brisbane, QLD, Australia
| | - Darren Neillie
- Community Forensic Outreach Service, Queensland Forensic Mental Health Service, Brisbane, QLD, Australia
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15
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Del Pozzo J, Cherneski L, Beck SJ, Lowe SR, Silverstein SM. Psychiatric Patients with a Serious Mental Illness and a Recent History of Violent Behavior: An Exploration of Developmental, Clinical, Cognitive, and Demographic Characteristics. CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2020. [DOI: 10.2174/2666082216999200425222601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Epidemiologic studies have shown that persons suffering from psychotic
disorders are at increased risk of violent behavior. Several factors have been shown to predict violent
behavior among persons with psychosis. However, prior research is limited in that these factors
have not been explored simultaneously within the same study.
Methods:
The current study, therefore, aimed to determine which demographic, clinical, cognitive,
and developmental characteristics were associated with an increased likelihood of violence among
patients diagnosed with a psychotic disorder and which combination of these best predicted a history
of violence. Participants (n=53) completed measures of demographics, violence risk, psychotic
and personality symptoms, trauma, psychopathy and cognitive functioning.
Results:
Bivariate relationships were conducted to compare the history of violent behavior between
all variables. Additionally, a binary logistic regression was run predicting participants’ history of
violence. Several demographic, cognitive, clinical, and developmental factors were associated with
increased odds of having a history of violence. The overall correct classification rate for the model
was 92.2%, with 87.5% of participants without a history of violence and 91.4% with a history of
violence being correctly classified. The model included antisocial personality traits, poor behavioral
controls, head injury, not accepting responsibility, lacking goals, prior supervision failures, and
HCR-20 total score.
Conclusion:
The binary logistic regression model showed good accuracy in predicting a history of
violence in persons with psychosis. These findings are consistent with prior research and can inform
efforts at risk assessment and identification of treatment targets for people with a psychotic disorder
who are at highest risk of violence.
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Affiliation(s)
- Jill Del Pozzo
- Department of Psychology, Montclair State University, Montclair, NJ 07043, United States
| | - Lindsay Cherneski
- Division of Schizophrenia Research, University Behavioral Health Care, Rutgers University, Piscataway, NJ 08854, United States
| | - Saul J. Beck
- Graduate School of Applied and Professional Psychology, Rutgers University, Piscataway, NJ 08854, United States
| | - Sarah R. Lowe
- Yale School of Public Health, Department of Social and Behavioral Sciences, Yale University, New Haven, CT 06520, United States
| | - Steven M. Silverstein
- School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY 14642, United States
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16
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Sakanaka S, Tsujii N, Morimoto H, Shirakawa O. Aggressiveness is associated with excitement on the five-factor model of the positive and negative syndrome scale and prefrontal function in patients with stable schizophrenia. Psychiatry Res 2020; 290:113054. [PMID: 32480116 DOI: 10.1016/j.psychres.2020.113054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/27/2020] [Accepted: 04/29/2020] [Indexed: 10/24/2022]
Abstract
Aggressiveness is a clinical concern in the stable phase of schizophrenia, as well as in the acute phase. The factors that affect aggressiveness during the stable phase remain unclear. This study investigated factors associated with aggressiveness in patients with stable schizophrenia. Sixty-six patients with schizophrenia who were in the stable phase without acute exacerbation were assessed for aggressiveness using the Buss-Perry Aggression Questionnaire; impulsivity using the Barratt Impulsiveness Scale Version 11, psychotic symptoms using the five-factor model of the Positive and Negative Syndrome Scale (PANSS) including positive symptoms, negative symptoms, disorganization, excitement, and emotional distress; and prefrontal hemodynamic responses using near-infrared spectroscopy. Multivariate regression analyses showed that the excitement factor of the PANSS five-factor model, which comprised four PANSS items (poor impulse control, hyperactivity, hostility, and uncooperativeness), and delayed prefrontal hemodynamic responses were associated with elevated aggressiveness. These findings suggest that in patients with stable schizophrenia, excitement symptoms and prefrontal dysfunction are associated with elevated aggressiveness. Furthermore, the impact of impulsive traits on aggressiveness is less relevant. Our results shed light on a specific aspect of aggressiveness in patients with stable schizophrenia and may indicate factors to consider in the clinical setting.
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Affiliation(s)
- Soichiro Sakanaka
- Department of Neuropsychiatry, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Noa Tsujii
- Department of Neuropsychiatry, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan.
| | - Hironobu Morimoto
- Department of Neuropsychiatry, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Osamu Shirakawa
- Department of Neuropsychiatry, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
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17
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Wang KZ, Bani-Fatemi A, Adanty C, Harripaul R, Griffiths J, Kolla N, Gerretsen P, Graff A, De Luca V. Prediction of physical violence in schizophrenia with machine learning algorithms. Psychiatry Res 2020; 289:112960. [PMID: 32361562 DOI: 10.1016/j.psychres.2020.112960] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 03/17/2020] [Accepted: 03/27/2020] [Indexed: 10/24/2022]
Abstract
Patients with schizophrenia have been shown to have an increased risk for physical violence. While certain features have been identified as risk factors, it has been difficult to integrate these variables to identify violent patients. The present study thus attempts to develop a clinically-relevant predictive tool. In a population of 275 schizophrenia patients, we identified 103 participants as violent and 172 as non-violent through electronic medical documentation, and conducted cross-sectional assessments to identify demographic, clinical, and sociocultural variables. Using these predictors, we utilized seven machine learning classification algorithms to predict for past instances of physical violence. Our classification algorithms predicted with significant accuracy compared to random discrimination alone, and had varying degrees of predictive power, as described by various performance measures. We determined that the random forest model performed marginally better than other algorithms, with an accuracy of 62% and an area under the receiver operator characteristic curve (AUROC) of 0.63. To summarize, machine learning classification algorithms are becoming increasingly valuable, though, optimization of these models is needed to better complement diagnostic decisions regarding early interventional measures to predict instances of physical violence.
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Affiliation(s)
- Kevin Z Wang
- Group for Suicide Studies, Centre for Addiction and Mental Health, 250 College St, M5T1R8, Toronto, Canada
| | - Ali Bani-Fatemi
- Group for Suicide Studies, Centre for Addiction and Mental Health, 250 College St, M5T1R8, Toronto, Canada
| | - Christopher Adanty
- Group for Suicide Studies, Centre for Addiction and Mental Health, 250 College St, M5T1R8, Toronto, Canada
| | - Ricardo Harripaul
- Group for Suicide Studies, Centre for Addiction and Mental Health, 250 College St, M5T1R8, Toronto, Canada
| | - John Griffiths
- Group for Suicide Studies, Centre for Addiction and Mental Health, 250 College St, M5T1R8, Toronto, Canada
| | - Nathan Kolla
- Group for Suicide Studies, Centre for Addiction and Mental Health, 250 College St, M5T1R8, Toronto, Canada
| | - Philip Gerretsen
- Group for Suicide Studies, Centre for Addiction and Mental Health, 250 College St, M5T1R8, Toronto, Canada
| | - Ariel Graff
- Group for Suicide Studies, Centre for Addiction and Mental Health, 250 College St, M5T1R8, Toronto, Canada
| | - Vincenzo De Luca
- Group for Suicide Studies, Centre for Addiction and Mental Health, 250 College St, M5T1R8, Toronto, Canada.
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18
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Impulsivity in early psychosis: A complex link with violent behaviour and a target for intervention. Eur Psychiatry 2020; 49:30-36. [DOI: 10.1016/j.eurpsy.2017.12.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 12/06/2017] [Accepted: 12/09/2017] [Indexed: 12/15/2022] Open
Abstract
AbstractBackgroundViolent behaviour (VB) occurs in first episode of schizophrenia and can have devastating impact both on victims and patients themselves. A better knowledge of the underlying mechanisms of VB may pave the way to preventive treatments.Objectives1) To explore the nature of the link between impulsivity and VB in early psychosis (EP) patients; 2) To explore the interactions between impulsivity and substance abuse, insight, and positive symptoms, the main dynamic risk factors of VB described to date.Design and methodsPost hoc analysis of data acquired in the frame of a 36-months EP cohort study. A total of 265 EP patients, aged 18 to 35, treated at TIPP (Treatment and early Intervention in Psychosis Program), at the Department of Psychiatry in Lausanne, Switzerland, were included in the study. Logistic regression analyzes were performed as well as mediation analysis and interaction analysisResultsOur data suggest that impulsivity is a predictor of VB when analyzed independently and as part of a multi-factorial model. Impulsivity continues to differentiate violent patients from non-violent ones at the end of the program. In addition, the relationship between impulsivity and VB is not mediated by substance abuse. Finally, the effect of impulsivity on the probability of VB is potentiated by the interaction of different levels of insight and positive symptoms.ConclusionsEarly intervention strategies in psychotic disorders should include evaluation of impulsivity considering it is linked to increased risk of VB and may respond to treatment.
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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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20
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Moulin V, Palix J, Golay P, Dumais A, Gholamrezaee MM, Azzola A, Baumann PS, Alameda L, Conus P. Violent behaviour in early psychosis patients: Can we identify clinical risk profiles? Early Interv Psychiatry 2019; 13:517-524. [PMID: 29143486 DOI: 10.1111/eip.12512] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 09/07/2017] [Accepted: 09/13/2017] [Indexed: 01/29/2023]
Abstract
AIMS The objective of this study is to explore, within a sample of early psychosis patients (EPP), if subgroups regarding rate of violent behaviour (VB) against others can be identified on the basis of dynamic risk factors (treatment modifiable characteristics). METHODS In a sample of 265 EPP, treated at the Treatment and Early Intervention in Psychosis Program in Lausanne, we conducted a latent-class analysis on the basis of the main dynamic VB risk factors (substance use disorder [SUD], positive symptoms, insight, and impulsivity). VB were restricted to "serious violence" and were assessed through patients self-report, interview with relatives or forensic services and with a standardized instrument. RESULTS The analysis confirmed the heterogeneity of the sample regarding rate of VB. Patients could be stratified within 4 subgroups, 3 of which were at increased risk of VB. The two groups with the highest rates of VB displayed specific clinical profiles. The first one was characterized by high levels of impulsivity, hostility, positive symptoms and SUD, and the second, by low level of insight and low social functioning. These patterns suggest that significant difficulties in social interaction may contribute to the emergence of aggressive reactions against others. CONCLUSIONS Identification of EPP at increased risk of VB seems possible on the basis of dynamic risk factors. If confirmed prospectively, this could pave the way to the development of preventive strategies and specific interventions.
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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 (CHUV), Lausanne, Switzerland
| | - Julie Palix
- Unit for Research in Legal Psychiatry and Psychology, Institute of Forensic Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Philippe Golay
- Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Alexandre Dumais
- Institut Philippe-Pinel de Montréal and Department of Psychiatry, Faculty of Medicine, University of Montréal, Quebec, Canada
| | - Mohammad Mehdi Gholamrezaee
- Centre for Psychiatric Epidemiology and Psychopathology, Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Agathe Azzola
- Unit for Research in Legal Psychiatry and Psychology, Institute of Forensic Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Philipp S Baumann
- Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Luis Alameda
- Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Philippe Conus
- Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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21
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Beck AT, Himelstein R, Bredemeier K, Silverstein SM, Grant P. What accounts for poor functioning in people with schizophrenia: a re-evaluation of the contributions of neurocognitive v. attitudinal and motivational factors. Psychol Med 2018; 48:2776-2785. [PMID: 29501072 DOI: 10.1017/s0033291718000442] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Neurocognitive deficits are often seen as core features of schizophrenia, and as primary determinants of poor functioning. Yet, our clinical observations suggest that individuals who score within the impaired range on standardized tests can reliably perform better in complex real-world situations, especially when performance is embedded within a positive socio-affective context. METHODS We analyzed literature on the influence of non-neurocognitive factors on test performance in order to clarify their contributions. RESULTS We identified seven non-neurocognitive factors that significantly contribute to neurocognitive test performance: avolition, dysfunctional attitudes, effort, stress, negative emotions, asociality, and disorganized symptoms. We then proposed an alternative model based on dysfunctional (e.g. defeatist) attitudes and their consequences for motivation and sustained task engagement. We demonstrated that these factors account for substantial variance in negative symptoms, neurocognitive test performance, and functional outcomes. We then demonstrated that recovery-oriented cognitive therapy - which is derived from this alternative model and primarily targets dysfunctional beliefs - has been successful in the treatment of low functioning individuals with schizophrenia. CONCLUSION The contributions of neurocognitive impairments to poor real-world functioning in people with schizophrenia may be overstated in the literature, and may even be limited relative to non-neurocognitive factors. We offer suggestions for further research to more precisely quantify the contributions of attitudinal/motivation v. neurocognitive factors in schizophrenia.
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Affiliation(s)
- Aaron T Beck
- Department of Psychiatry,University of Pennsylvania,Philadelphia,Pennsylvania,USA
| | - Robyn Himelstein
- Department of Psychiatry,University of Pennsylvania,Philadelphia,Pennsylvania,USA
| | - Keith Bredemeier
- Center for Assessment Research and Translation,University of Delaware,Newark,Delaware,USA
| | - Steven M Silverstein
- Department of Psychiatry,Rutgers - Robert Wood Johnson Medical School,Piscataway Township,New Jersey,USA
| | - Paul Grant
- Department of Psychiatry,University of Pennsylvania,Philadelphia,Pennsylvania,USA
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22
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Moulin V, Alameda L, Baumann PS, Gholamrezaee MM, Palix J, Gasser J, Conus P. [Three clinical risk profiles of violent behavior in a cohort of early psychosis patients]. L'ENCEPHALE 2018; 45:214-220. [PMID: 30446287 DOI: 10.1016/j.encep.2018.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 08/21/2018] [Accepted: 08/26/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE This study aims to determine whether it is possible to identify clinical profiles at risk of violent behaviors (VB) in the early phase of psychotic disorders, on the basis of the main dynamic psychopathological risk factors and describe characteristics of the groups with highest levels of violent behaviors. METHOD A total of 265 patients, aged 18 to 35, treated at the Treatment and early Intervention in Psychosis Program (TIPP-Lausanne), a specialized early psychosis program, were included in this study. We conducted a latent-class analysis and a discriminative analysis on the basis of the main dynamic VB risk factors: substance use disorder, impulsivity, positive symptoms, insight, aggression, hostility, anger, emotional instability and adherence to treatment. These factors were evaluated by specialized scales and on the basis of the Positive and Negative Syndrome Scale (PANSS). VB were restricted to physical aggression against people, defined as "serious violence". They were assessed on the basis of a questionnaire listing violent offenses (Swiss Criminal Code) and VB such as assault and battery, information through the forensic psychiatric services and on the basis of the Staff Observation Aggression Scale (SOAS-R scale) during inpatient treatment phase. RESULTS Four heterogeneous subgroups were identified with respect to the studied clinical characteristics, including two groups with high rates of VB. The first group, comprising 46% of patients with VB, is distinguished by the prevalence of a range of dimensions related to hostility, impulsivity and emotional instability, associated with high levels of substance abuse and positive symptoms. These clinical dimensions are very significant at the statistical level, since they explain 70% of the construction of subgroups (discriminant analysis). The second group with 37% of patients with VB, is characterized by a lack of insight, lack of adherence to treatment and substance use. These two clinical profiles could increase the impairment of cognitive, functional and relational abilities and contribute to the development of VB in this early phase of psychosis. The third subgroup, with a violent behaviors rate of 28.6%, is distinguished by its high proportion of diagnoses of substance abuse (100%) and women (54%). A last subgroup of patients, the largest quantitatively, has a low proportion of VB (15%) and the lowest levels on the studied factors, suggesting that the majority of patients with this profile commit few VB. CONCLUSION Our results show that it is possible to identify groups at risk of violent behaviors during the early phase of psychosis on the basis of clinical characteristics that may evolve and therefore be the focus of preventive care. These results highlight the need to target substance use, impulsivity and lack of insight at follow-up in order to prevent VB.
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Affiliation(s)
- V Moulin
- Unité de recherche en psychiatrie et psychologie légales, institut de psychiatrie légale, département de psychiatrie du centre hospitalier universitaire Vaudois (CHUV), site de Cery, bâtiment Les Cèdres, 1008 Prilly-Lausanne, Suisse.
| | - L Alameda
- Service de psychiatrie générale, centre de neuroscience psychiatrique, département de psychiatrie du centre hospitalier universitaire Vaudois (CHUV), Lausanne, Suisse; Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - P S Baumann
- Service de psychiatrie générale, département de psychiatrie du centre hospitalier universitaire Vaudois (CHUV), Lausanne, Suisse
| | - M M Gholamrezaee
- Centre d'épidémiologie psychiatrique et psychopathologie, département de psychiatrie du centre hospitalier universitaire Vaudois (CHUV), Lausanne, Suisse
| | - J Palix
- Unité de recherche en psychiatrie et psychologie légales, institut de psychiatrie légale, département de psychiatrie du centre hospitalier universitaire Vaudois (CHUV), site de Cery, bâtiment Les Cèdres, 1008 Prilly-Lausanne, Suisse
| | - J Gasser
- Institut de psychiatrie légale, département de psychiatrie du centre hospitalier universitaire Vaudois (CHUV), Lausanne, Suisse
| | - P Conus
- Service de psychiatrie générale, département de psychiatrie du centre hospitalier universitaire Vaudois (CHUV), Lausanne, Suisse
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23
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Leclerc MP, Regenbogen C, Hamilton RH, Habel U. Some neuroanatomical insights to impulsive aggression in schizophrenia. Schizophr Res 2018; 201:27-34. [PMID: 29908715 DOI: 10.1016/j.schres.2018.06.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 04/04/2018] [Accepted: 06/09/2018] [Indexed: 10/14/2022]
Abstract
Patients with schizophrenia are at increased risk of engaging in violence towards others, compared to both the general population and most other patient groups. We have here explored the role of cortico-limbic impairments in schizophrenia, and have considered these brain regions specifically within the framework of a popular neuroanatomical model of impulsive aggression. In line with this model, evidence in patients with aggressive schizophrenia implicated structural deficits associated with impaired decision-making, emotional control and evaluation, and social information processing, especially in the orbitofrontal and ventrolateral prefrontal cortex. Given the pivotal role of the orbitofrontal and ventrolateral cortex in emotion control and evaluation, structural deficits may result in inappropriate use of socially relevant information and improper recognition of impulses that are in need for regulation. Furthermore, we have extended the original model and incorporated the striatum, important for the generation of aggressive impulses, as well as the hippocampus, a region critical for decision-making, into the model. Lastly, we discuss the question whether structural impairments are specific to aggressive schizophrenia. Our results suggest, that similar findings can be observed in other aggressive patient populations, making the observed impairments non-specific to aggressive schizophrenia. This points towards a shared condition, across pathologies, a potential common denominator being impulsive aggression.
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Affiliation(s)
- Marcel P Leclerc
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Germany; JARA - BRAIN Institute 1: Structure Function Relationship, Jülich, Germany.
| | - Christina Regenbogen
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Germany; JARA - BRAIN Institute 1: Structure Function Relationship, Jülich, Germany; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Roy H Hamilton
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Ute Habel
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Germany; JARA - BRAIN Institute 1: Structure Function Relationship, Jülich, Germany
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24
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Gwarjanski AR, Parrott S. Schizophrenia in the News: The Role of News Frames in Shaping Online Reader Dialogue about Mental Illness. HEALTH COMMUNICATION 2018; 33:954-961. [PMID: 28537757 DOI: 10.1080/10410236.2017.1323320] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A quantitative content analysis examined the portrayal of schizophrenia in eight of the most read online news publications in the United States. The analysis documented the prevalence of stigma frames, which communicate stereotypes concerning schizophrenia, and stigma-challenge frames, which contradict stereotypes, in 558 articles related to schizophrenia. The study also examined the relationship between media framing and reader commentary, including the likelihood of readers posting stigmatizing comments, stigma-challenging comments, and comments in which they disclosed personal experience with mental illness. Stigma frames were prevalent in the sample, suggesting the news media continue associating schizophrenia with violent and criminal behavior. Stigma frames stood greater chance of being accompanied by stigmatizing comments from readers when compared to stigma-challenging frames. Conversely, stigma-challenging frames stood greater chance of being accompanied by stigma-challenging comments from readers. Readers were more likely to disclose personal experience with mental illness when they encountered a stigma-challenging frame. Recommendations are made for journalists and health communicators.
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Affiliation(s)
| | - Scott Parrott
- a Department of Journalism & Creative Media , The University of Alabama
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25
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Bushman BJ, Coyne SM, Anderson CA, Björkqvist K, Boxer P, Dodge KA, Dubow EF, Farrington DP, Gentile DA, Huesmann LR, Lansford JE, Novaco RW, Ostrov JM, Underwood MK, Warburton WA, Ybarra ML. Risk factors for youth violence: Youth violence commission, International Society For Research On Aggression (ISRA). Aggress Behav 2018; 44:331-336. [PMID: 29913051 DOI: 10.1002/ab.21766] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 04/29/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Brad J. Bushman
- School of CommunicationDepartment of Psychology The Ohio State UniversityColumbusOhio
| | | | - Craig A. Anderson
- Center for Study of ViolenceDepartment of PsychologyIowa State UniversityAmesIowa
| | - Kaj Björkqvist
- Department of Social SciencesÅbo Akademi UniversityVasaFinland
| | - Paul Boxer
- Center on Youth Violence and Juvenile JusticeDepartment of PsychologyRutgers University‐NewarkNewarkNew Jersey
| | - Kenneth A. Dodge
- Sanford School of Public PolicyDuke UniversityDurhamNorth Carolina
| | - Eric F. Dubow
- Department of PsychologyBowling Green State UniversityBowling Green, OhioUniversity of Michigan, Institute for Social ResearchAnn ArborMichigan
| | | | | | - L. Rowell Huesmann
- Institute for Social Research and Department of Communication StudiesUniversity of MichiganAnn ArborMichigan
| | | | - Raymond W. Novaco
- Department of Psychology and Social BehaviorUniversity of CaliforniaIrvine
| | - Jamie M. Ostrov
- Department of PsychologyUniversity at BuffaloThe State University of New YorkBuffaloNew York
| | - Marion K. Underwood
- School of Behavioral and Brain SciencesUniversity of Texas at DallasRichardsonTexas
| | - Wayne A. Warburton
- Department of PsychologyMacquarie UniversitySydneyNew South WalesAustralia
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26
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Moulin V, Palix J, Alameda L, Gholamrezaee MM, Baumann PS, Gasser J, Elowe J, Solida A, Conus P. [Insight and Violent Behavior in a Cohort of Early Psychosis Patients]. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:20-29. [PMID: 28655283 PMCID: PMC5788119 DOI: 10.1177/0706743717718173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES: An important proportion of patients with first episode psychosis behave in a violent, hetero-aggressive manner. This study aims to explore the association between insight and violent behavior (VB), and insight evolution in the follow-up period. METHOD: The study was carried out with a prospective cohort of 265 patients recruited from the early treatment and intervention for psychotic disorders program, and followed for a 3-year period. Insight assessing is based on a 3-item scale and the insight item in Positive and Negative Syndrome Scale (PANSS). VBs were evaluated by case managers, information from forensic services and through a record of VBs noted during hospitalization. Univariate and multivariate logistic regression analyses, t-tests and correlations were conducted. RESULTS: The significant effect of insight as a factor associated with VBs that was found in univariate analyses disappears after controlling for the effect of positive symptoms, substance addiction diagnosis, impulsivity and treatment compliance. CONCLUSION: If patient insight in their illness develops positively during treatment, our results suggest that the risk of VBs occurring is not influenced by insight level. On the other hand, it is significantly linked to substance abuse and impulsivity, which might implicate focusing on these 2 dimensions in preventive strategies. Insight impact on VB should be further explored in more focused prospective analyses.
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Affiliation(s)
- Valerie Moulin
- 1 Unité de Recherche en Psychiatrie et Psychologie Légales, Institut de Psychiatrie légale, Département de Psychiatrie du Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Suisse
| | - Julie Palix
- 1 Unité de Recherche en Psychiatrie et Psychologie Légales, Institut de Psychiatrie légale, Département de Psychiatrie du Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Suisse
| | - Luis Alameda
- 2 Service de Psychiatrie Générale, Service de Psychiatrie de Liaison et Centre de Neuroscience Psychiatrique, Département de Psychiatrie du Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Suisse
| | - M Mehdi Gholamrezaee
- 3 Centre d'épidémiologie psychiatrique et psychopathologie, Département de Psychiatrie du Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Suisse
| | - Philipp S Baumann
- 4 Service de Psychiatrie Générale, Département de Psychiatrie du Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Suisse
| | - Jacques Gasser
- 5 Institut de Psychiatrie légale, Département de Psychiatrie du Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Suisse
| | - Julien Elowe
- 6 Secteur psychiatrique ouest, Département de Psychiatrie du Centre Hospitalier Universitaire Vaudois (CHUV), Prangins, Suisse
| | - Alessandra Solida
- 4 Service de Psychiatrie Générale, Département de Psychiatrie du Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Suisse
| | - Philippe Conus
- 4 Service de Psychiatrie Générale, Département de Psychiatrie du Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Suisse
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27
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Widmayer S, Borgwardt S, Lang UE, Stieglitz RD, Huber CG. Functional Neuroimaging Correlates of Aggression in Psychosis: A Systematic Review With Recommendations for Future Research. Front Psychiatry 2018; 9:777. [PMID: 30804823 PMCID: PMC6370727 DOI: 10.3389/fpsyt.2018.00777] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 12/24/2018] [Indexed: 12/19/2022] Open
Abstract
Background and methods: Aggression in psychosis is clinically important. We systematically compiled the evidence on functional correlates of aggression in psychosis searching PubMed, EMBASE, ScienceDirect, and PsycINFO until September 2017. We included studies reporting functional brain imaging correlates of aggression comparing: (1) affective or non-affective psychosis groups with a history of violence or with aggression operationalized using questionnaires, (2) affective or non-affective psychosis groups with a history of violence or with aggression operationalized using questionnaires to controls, (3) affective or non-affective psychosis groups with a history of violence or with aggression operationalized using questionnaires to controls with diagnoses other than affective or non-affective psychoses. We applied no language restriction and required patients to have a DSM or ICD diagnosis of affective or non-affective psychosis. Results: Our sample consisted of 12 studies with 334 patients and 113 controls. During n-back tasks, violent (VS) as opposed to non-violent persons with schizophrenia (NVS) hypoactivated their inferior parietal lobe. When anticipating shock, VS vs. NVS hyperactivated their medial prefrontal gyrus, cuneus, middle temporal gyrus, and middle occipital gyrus. When viewing negative emotional pictures, VS vs. NVS hyperactivated the middle frontal gyrus, inferior frontal gyrus, anterior cingulate, lingual gyrus, precentral gyrus, globus pallidus, mid-cingulate, and precuneus. Limitations: Due to the small number of available studies, sample overlap, and insufficient reporting of relevant moderators we could not conduct a meta-analysis. Conclusions: We found non-systematic functional correlates of aggression in schizophrenia. Only few studies using varied paradigms and often overlapping samples have been conducted. There have been no attempts to replicate any of the observed findings in the published literature. Focusing on future directions, we recommend that authors adhere to clear definitions of aggression, measurements of psychopathology, comorbidities, and medication. In particular, replication studies would allow for a better synthesis of the findings. PROSPERO Registration Number: CRD42016048579.
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Affiliation(s)
- Sonja Widmayer
- Department of Psychiatry, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Stefan Borgwardt
- Department of Psychiatry, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Undine E Lang
- Department of Psychiatry, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Rolf-Dieter Stieglitz
- Department of Psychiatry, University Hospital Basel, University of Basel, Basel, Switzerland.,Psychological Faculty, University of Basel, Basel, Switzerland
| | - Christian G Huber
- Department of Psychiatry, University Hospital Basel, University of Basel, Basel, Switzerland
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28
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LaVan M, LaVan H, Martin WMM. Antecedents, Behaviours, and Court Case Characteristics and Their Effects on Case Outcomes in Litigation for Persons with Schizophrenia. PSYCHIATRY, PSYCHOLOGY, AND LAW : AN INTERDISCIPLINARY JOURNAL OF THE AUSTRALIAN AND NEW ZEALAND ASSOCIATION OF PSYCHIATRY, PSYCHOLOGY AND LAW 2017; 24:866-887. [PMID: 31983996 PMCID: PMC6818312 DOI: 10.1080/13218719.2017.1316176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A 10% random sample of 3543 cases litigated in the United States' civil and criminal courts were analysed using logistic regression to develop a model that can predict case outcomes for litigants with schizophrenia. Most predictors are related to case characteristics and not to the litigants' antecedents, behaviours or medication issues. Only the psychologist as an expert witness was found to be related to case outcome, but the concern is expressed that inadequate weight is given to expert testimony. Other significant findings include being represented by counsel, atypical medication and malingering.
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Affiliation(s)
- Melissa LaVan
- The Chicago School of Professional
Psychology, Grand Island, NE, USA
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29
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Pinkham AE, Harvey PD, Penn DL. PARANOID INDIVIDUALS WITH SCHIZOPHRENIA SHOW GREATER SOCIAL COGNITIVE BIAS AND WORSE SOCIAL FUNCTIONING THAN NON-PARANOID INDIVIDUALS WITH SCHIZOPHRENIA. SCHIZOPHRENIA RESEARCH-COGNITION 2016; 3:33-38. [PMID: 27990352 PMCID: PMC5156478 DOI: 10.1016/j.scog.2015.11.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Paranoia is a common symptom of schizophrenia that may be related to how individuals process and respond to social stimuli. Previous investigations support a link between increased paranoia and greater social cognitive impairments, but these studies have been limited to single domains of social cognition, and no studies have examined how paranoia may influence functional outcome. Data from 147 individuals with schizophrenia were used to examine whether actively paranoid and non-paranoid individuals with schizophrenia differ in social cognition and functional outcomes. On measures assessing social cognitive bias, paranoid individuals endorsed more hostile and blaming attributions and identified more faces as untrustworthy; however, paranoid and non-paranoid individuals did not differ on emotion recognition and theory of mind tasks assessing social cognitive ability. Likewise, paranoid individuals showed greater impairments in real-world interpersonal relationships and social acceptability as compared to non-paranoid patients, but these differences did not extend to performance based tasks assessing functional capacity and social competence. These findings isolate specific social cognitive disparities between paranoid and non-paranoid subgroups and suggest that paranoia may exacerbate the social dysfunction that is commonly experienced by individuals with schizophrenia.
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Affiliation(s)
- Amy E Pinkham
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, 75080; Department of Psychiatry, University of Texas Southwestern Medical School, Dallas, TX, 75390
| | - Philip D Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, 33136; Research Service, Bruce W Carter VA Medical Center, Miami, FL, 33125
| | - David L Penn
- Department of Psychology, University of North Carolina, Chapel Hill, NC, 27599; Australian Catholic University, Melbourne, VIC 3065
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30
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An SK. Violent behavior in individuals with schizophrenia. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2016. [DOI: 10.5124/jkma.2016.59.12.947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Suk Kyoon An
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Korea
- Section of Self, Affect and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea
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31
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Esbec E, Echeburúa E. Violencia y esquizofrenia: un análisis clínico-forense. ANUARIO DE PSICOLOGÍA JURÍDICA 2016. [DOI: 10.1016/j.apj.2015.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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