Integrating Religion and Spirituality into Psychiatric Outpatient Treatment in the United States

It is common for mental health clients to desire that religion and spirituality (RS) be integrated into their treatment. Despite this preference, clients' RS beliefs often go overlooked in therapy for a variety of reasons including lack of provider training on integration, fear of causing offense, or concerns about wrongly influencing clients. The present study assessed the effectiveness of using a psychospiritual therapeutic curriculum to integrate RS into psychiatric outpatient treatment for highly religious clients (n = 150) seeking services through a faith-based clinic. The curriculum was well accepted by both clinicians and clients, and a comparison of clinical assessments administered at intake and program exit (clients averaged 6.5 months in the program) showed significant improvement across a broad range of psychiatric symptoms. These results suggest the use of a religiously integrated curriculum within a broader psychiatric treatment program is beneficial and may be a way to overcome clinicians' RS concerns and shortcomings while meeting religious clients' desires for inclusion.

Pharmacotherapy of Primary Impulsive Aggression in Violent Criminal Offenders

Primary impulsive aggression (PIA) can be implicated as a common factor that results in an arrest, disciplinary, and restraint measures during confinement, and criminal recidivism after release. Evidence suggests that anti-impulsive aggression agents (AIAAs) can diminish or prevent impulsive aggression even when occurring with personality pathology such as borderline or antisocial personality disorder (ASPD), common conditions in offender populations. A previous review identified agents that have been subjected to controlled drug trials of sufficient quality, and subsequently, a decisional algorithm was developed for selecting an AIAA for individuals with IA. This selection process began with the five agents that showed efficacy in two or more quality studies from the earlier review. Today, 8 years after the quality review study, the present authors undertook this follow-up literature review. The aims of the present review were to survey the literature to identify and assess: (1) drug trials of comparable quality published since the 2013 review, including trials of the previously identified AIAAs as well as trials of agents not included in the earlier review; (2) severity of aggressive outbursts; (3) the materiality of risks or side-effects that are associated with individual AIAAs as well as antipsychotic agents commonly used to control clinical aggression; (4) efficacy of these agents in special populations (e.g., females); and (5) cost and convenience of each agent. Improved pharmacotherapy of PIA by addressing risks, side effects and practicality as well as the efficacy of AIAAs, should promote the rehabilitation and reintegration of some pathologically aggressive offenders back into the community.

Manage Emotions to Reduce Aggression: A Pilot Study of a Brief Treatment to Help Veterans Reduce Impulsive Aggression

Veterans with posttraumatic stress disorder (PTSD) report more aggression than civilians with PTSD. Because emotion regulation difficulties mediated the relationship between PTSD symptoms and impulsive aggression in veterans, we developed an intervention to increase emotion regulation skills. This pilot study tested the feasibility and acceptability of a three-session treatment, Manage Emotions to Reduce Aggression (MERA), and examined its effectiveness at reducing aggression and emotion dysregulation. Male combat veterans with PTSD and impulsive aggression completed assessments before and 4 weeks after MERA. Overt Aggression Scale measured frequency of aggression; Difficulties in Emotion Regulation Scale assessed emotion dysregulation. Most veterans (95%) who completed MERA and the posttreatment assessment (n = 20) reported MERA was helpful. Veterans in the intent-to-treat sample demonstrated a significant decrease in their frequency of aggression (Cohen's d = -0.55) and emotion dysregulation (Cohen's d = -0.55). MERA may be an innovative treatment that helps veterans reduce aggression.

Client Attitudes toward Integrating Religion and Spirituality in Mental Health Treatment: Scale Development and Client Responses

This article describes the development, validation, and responses to the first administration of the Religious/Spiritually Integrated Practice Assessment Scale-Client Attitudes (RSIPAS-CA). A total of 1,047 U.S. adults responded to an online survey administered by Qualtrics, which included the RSIPAS-CA for secondary analysis. Of those, 245 indicated they were either current or former mental health clients and thus were asked to complete a 10-item instrument assessing clients' attitudes toward integrating religion and spirituality (RS) in mental health treatment. A confirmatory factor analysis showed the current sample's data approached an adequate fit, and the instrument's reliability was considered very good (α = .89). Descriptive analyses indicated that clients have mixed views regarding who should initiate the discussion of RS, but a majority responded favorably toward integrating RS in practice. The article ends with a general comparison between client responses to the current survey and clinical social workers' responses to the practitioners' RSIPAS. It also discusses implications for research based on the scale development and implications for practice and education, based on client preferences.

A test of the psychometric characteristics of the BIS-Brief among three groups of youth

The Barratt Impulsiveness Scale (BIS-11) is the most widely administered trait impulsiveness questionnaire. Recently a shorter, unidimensional version of the instrument was developed for adults (BIS-Brief). While psychometric characteristics of the BIS-Brief support its use among adults, it also may be more appropriate for youth samples than the complete BIS-11 because it less burdensome and omits items about activities not usually encountered by children and adolescents. This article describes a test of psychometric characteristics of the BIS-Brief among youth. To measure a sufficiently wide range of scores, analyses were conducted based on secondary data analysis of data sets pooled from 3 distinct youth cohorts aged 10-17: healthy controls (Control; n = 356); those who had a family history of substance use disorder (FH+; n = 302); and psychiatric inpatients (Patients; n = 322). Model fit for the BIS-Brief was good but varied somewhat depending on the respondent cohort. There was a strong correlation between test and re-test BIS-Brief both within a single day and at 6 months, and also a strong correlation between BIS-Brief and BIS-11 scores. Concurrent validity was supported by correlation with questionnaire measures, which tended to be more robustly associated with BIS-Brief than behavioral measures. Both BIS-Brief and BIS-11 forms were similarly associated with other convergent measures. In conclusion, the BIS-Brief is a shorter version of the BIS-11 that reduces participant burden and with psychometric properties that support its use among youth populations. (PsycINFO Database Record

Heightened early-attentional stimulus orienting and impulsive action in men with antisocial personality disorder

We tested whether enhanced stimulus orienting operationalized as N1 and P2 auditory evoked potentials to increasing loudness (50-90 dB clicks) could be associated with trait impulsivity (Barratt Impulsiveness Scale, BIS-11), impulsive action (commission error on the Immediate Memory Task), or impulsive choice (immediate responses on temporal discounting tasks). We measured N1 and P2 loudness sensitivity in a passive listening task as linear intensity-sensitivity slopes in 36 men with antisocial personality disorder with a history of conviction for criminal conduct and 16 healthy control men. Across all subjects, regression analyses revealed that a steeper P2 slope predicted higher IMT commission error/correct detection ratio, and lower stimulus discriminability (A-prime). These associations were also found within both groups. These relationships suggest an association between enhanced early stimulus orienting (P2), impulsive action (response inhibition), and impaired signal-noise discriminability (A-prime).

A Proposed Algorithm for the Pharmacotherapy of Impulsive Aggression

A rational algorithm for effective pharmacotherapy for impulsive aggression takes into account five factors: sufficiently defined and characterized aggressive behavior; availability of agents studied by trials of sufficient quality; risks, side effects, and contraindications; severity of aggressive outbursts; and co-occurring mental and medical conditions. Clinicians in forensic and correctional treatment centers, indeed in any treatment setting, should be able to optimize their effectiveness in treating impulsive aggression by using methods that consider these five factors.

Clergy Perceptions of Sexual Assault Victimization

Although congregants often turn to clergy for help in dealing with personal difficulties, including marital problems, substance abuse issues, and mental illness, survivors of sexual assault do not commonly turn to clergy for support or guidance. This study utilized a mixed-methods approach, online survey, and semi-structured interviews to determine how clergy perceive sexual assault victimization. The results of this study showed that more blame was assigned to the victim as the relationship with the perpetrator became closer, with the exception of marital rape. This study also found that hostile sexism was a predictor of negative attitudes toward rape victims.

Feasibility and efficacy of a peer-led recovery group program for war-related trauma in Libya

After 42 years under the brutal rule of Colonel Muammar al-Gaddafi, the people of Libya rose up on 17 February 2011 and demanded change. The 9-month civil war that followed resulted in the deaths of approximately 15,000 Libyans. This study reports on the feasibility and efficacy of a 10-week peer-led group-based recovery intervention for war-related trauma implemented at the Garyounis internally displaced person camp outside of the city of Benghazi. The results of this preliminary assessment show that the use of peers to lead recovery groups for war-related trauma is not only feasible but also appears to be highly efficacious in reducing posttraumatic stress disorder symptoms in civilians. The reported subjective experiences of those involved in facilitating the groups suggest that the use of peers, rather than mental health professionals, is a realistic option to minimize the long-term effects of war-related trauma.

Pharmacotherapy of impulsive aggression: a quality comparison of controlled studies

The present study assessed the quality of pharmacotherapy trials to treat impulsive aggressive behavior. While a search of the literature found 55 peer-reviewed published studies on the pharmacotherapy of aggression, only 23 met criteria for inclusion in the quality analysis. To be included in this review, the study must have had at least one comparison group to control for placebo effects. The study must have also adequately defined and diagnosed the presence of impulsive aggression or intermittent explosive disorder. The primary reason studies were excluded from the quality analysis was that impulsive aggression was not specifically defined as the behavior being treated (25 of 32, 78%). The results of the quality analysis found that higher quality studies (n=10; 45%) were characterized by a clear definition of impulsive aggression; specific criteria for what constitutes an impulsive aggressive act; the exclusion of participants with neurological disorders, serious mental disorders, and/or low IQ; and information concerning the serum levels of the medication being investigated. A significant weakness found in the literature is the paucity of high quality studies accessing the efficacy of pharmacological agents other than anticonvulsants for the treatment of impulsive aggression.

Association of the COMT Met¹⁵⁸ allele with trait impulsivity in healthy young adults

Dopamine (DA) is considered to be an important neurotransmitter in the control of impulsive behavior, however, its underlying mechanisms have not been fully elucidated. Catechol-O-methyltransferase (COMT) is a key enzyme in the catabolism of DA within the prefrontal cortex (PFC) and has been suggested to play a role in the mediation of impulsive behavior. The COMT single nucleotide polymorphism (SNP) rs4680 (Val158Met) Met allele has been shown to decrease COMT enzyme activity and is associated with improved PFC cognitive function (intelligence and executive functions). Studies have associated the rs4680 genotype with impulsivity as a symptom in attention deficit hyperactivity disorder and substance abuse. However, only a few studies have assessed the effects of rs4680 on impulsiveness in healthy subjects, the results of which remain controversial. The Barratt Impulsiveness Scale (BIS-11) was applied to 82 healthy volunteers (including 42 females) who were genotyped for COMT rs4680. Subjects carrying the Met/Met genotype scored higher for the BIS-11 second-order factor Non-planning than carriers of the Val/Val genotype. No interaction between gender genotype was detected. Age, gender and education had no effect on the results. The COMT rs4680 Met/Met genotype was associated with higher impulsivity on the BIS-11 second-order factor Non-planning. These results suggest that COMT enzyme activity may be important in the regulation of impulsiveness among young adults. Further studies involving larger samples should be conducted to confirm the results of the present study.

New tricks for an old measure: the development of the Barratt Impulsiveness Scale-Brief (BIS-Brief)

The Barratt Impulsivity Scale (BIS), a 30-item self-report measure, is one of the most commonly used scales for the assessment of the personality construct of impulsiveness. It has recently marked 50 years of use in research and clinical settings. The current BIS-11 is held to measure 3 theoretical subtraits, namely, attentional, motor, and non-planning impulsiveness. We evaluated the factor structure of the BIS using full information item bifactor analysis for Likert-type items. We found no evidence supporting the 3-factor model. In fact, half of the items do not share any relation with other items and do not form any factor. In light of this, we introduce a unidimensional Barratt Impulsiveness Scale-Brief (BIS-Brief) that includes 8 of the original BIS-11 items. Next, we present evidence of construct validity comparing scores obtained with the BIS-Brief against the original BIS total scores using data from (a) a community sample of borderline personality patients and normal controls, (b) a forensic sample, and (c) an inpatient sample of young adults and adolescents. We demonstrated similar indices of construct validity that is observed for the BIS-11 total score with the BIS-Brief score. Use of the BIS-Brief in clinical assessment settings and large epidemiological studies of psychiatric disorders will reduce the burden on respondents without loss of information.

Demonstrating emotional processing differences in psychopathy using affective ERP modulation

Psychopaths exhibit abnormalities processing emotional information, but there is less certainty regarding the role attention plays in these processes. We present data from two affective picture-viewing tasks comparing event-related potential (ERP) modulation effects when emotional information is present but not task relevant (Task 1) followed by a condition directing attention to the categorization of emotional content (Task 2). Controls show a robust, persistent ERP positivity (200-900 ms) associated with emotional target photos compared to neutral targets in both tasks. Individuals with psychopathy only showed this differentiation when explicitly attending to the emotional content of the photos (Task 2), and these effects remained smaller than the amplitude differences demonstrated by controls. Although abnormal allocation of attention may play a critical role, this cannot completely account for emotional processing deficits associated with psychopathy.

High psychopathic trait females exhibit reduced startle potentiation and increased p3 amplitude

While there has been steady progress in identifying psychophysiological traits associated with psychopathy, most of the existing research has been carried out using incarcerated male participants, and data that include females are particularly rare. This study examined both affective startle blink modulation and P3 amplitude in a sample of female undergraduates grouped by scores on the Psychopathic Personality Inventory-Revised (PPI-R). Those scoring high for psychopathic traits lacked startle blink potentiation and demonstrated larger P3 amplitudes during auditory and visual oddball tasks. These data support the generalizability of deficient startle potentiation to non-incarcerated females with psychopathic traits, and add to a growing body of literature suggesting that psychopathic traits are associated with distinctive information-processing characteristics as indexed by P3 amplitude.

Pharmacologic treatment of impulsive aggression with antiepileptic drugs

Aggressive behavior is a major concern in mental health and criminal justice settings. Although pharmacotherapy is often used in the treatment of the violent individual, no medication is presently approved by the US Food and Drug Administration specifically for such use. In recent years, antiepileptic drugs (AEDs) have become increasingly popular for the management of impulsive (reactive) aggressive behavior. The research literature has implicated several neurobiologic deficits associated with impulsive aggression, including reduced central serotonergic functioning, executive dysfunction, and prefrontal deficits. It has been suggested that the neurobiologic deficits specific to impulsive aggressive behavior may serve as indicators of an ineffective behavioral control system. A review of the literature finds that AEDs, particularly those that block sodium channels and/or have GABA-related mechanisms of action, are effective in reducing the frequency and intensity of impulsive aggressive outbursts both when used as the primary agent of treatment and as an adjunct to ongoing pharmacotherapy. Strong evidence for efficacy in impulsive aggression exists from randomized controlled trials for most of the common AEDs (phenytoin, carbamazepine, oxcarbazepine, lamotrigine, valproate/divalproex sodium, topiramate). Additional controlled studies are needed for tiagabine and gabapentin. Of the common AEDs, only levetiracetam has been shown to be ineffective in the treatment of impulsive aggression. It is important to note that the anti-aggressive effects seen with the AEDs appear to be specific to the impulsive form of aggression. Individuals who display premeditated aggression do not seem to benefit from this type of treatment. Clinically, we recommend phenytoin (initial dose 100 mg three times daily) as the AED of first choice for the treatment of impulsive aggressive outbursts. This recommendation is based on this drug's limited side effect profile (compared with the other AEDs) and the large amount of empiric data supporting its clinical efficacy in impulsive aggression. In the event that the impulsive aggressive individual does not respond to pharmacotherapy with phenytoin, carbamazepine (initial dose 150 mg three times daily) and valproate/divalproex sodium (initial dose 250 mg three times daily) have both proved to be effective secondary options.

Assessing behavioural manifestations prior to clinical diagnosis of huntington disease: "anger and irritability" and "obsessions and compulsions"

The Functional Rating Scale Taskforce for pre-Huntington Disease (FuRST-pHD) is a multinational, multidisciplinary initiative with the goal of developing a data-driven, comprehensive, psychometrically sound, rating scale for assessing symptoms and functional ability in prodromal and early Huntington disease (HD) gene expansion carriers. The process involves input from numerous sources to identify relevant symptom domains, including HD individuals, caregivers, and experts from a variety of fields, as well as knowledge gained from the analysis of data from ongoing large-scale studies in HD using existing clinical scales. This is an iterative process in which an ongoing series of field tests in prodromal (prHD) and early HD individuals provides the team with data on which to make decisions regarding which questions should undergo further development or testing and which should be excluded. We report here the development and assessment of the first iteration of interview questions aimed to assess "Anger and Irritability" and "Obsessions and Compulsions" in prHD individuals.

Hypnosis in the treatment of Morgellons disease: a case study

Morgellons Disease is a condition involving painful skin lesions, fibrous growths protruding from the skin, and subcutaneous stinging and burning sensations, along with symptoms of anxiety, depression, fatigue, and memory and attention deficits. The etiological and physiological bases of these symptoms are unclear, making the diagnosis controversial and challenging to treat. There are currently no established treatments for Morgellons Disease. The following case example depicts treatment of a woman with Morgellons Disease using hypnotherapy. Data from this case example suggest that hypnotherapy is a promising intervention for the physical and psychological symptoms associated with Morgellons Disease.

P3a amplitude predicts successful treatment program completion in substance-dependent individuals

This study examined P3a amplitude as a direct predictor of treatment success for substance dependence. Participants were 35 adults (27 men, 8 women) undergoing treatment for substance dependence at an urban residential treatment facility between October 2005 and July 2007. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria were used to confirm substance dependence. P3a amplitude was significantly smaller for those who dropped out of treatment. Discriminant function analysis confirmed that P3a amplitude was a robust predictor of treatment completion, more sensitive than other measures including substance abuse severity. Implications for the interpretation of P3a amplitude as an index of executive function are discussed.

Association of P3 amplitude to treatment completion in substance dependent individuals

Individuals with substance use disorders typically show reduced amplitudes of the P3 component of the evoked potential and high scores on impulsivity and aggression measures. The present study investigated the usefulness of P3 amplitude, addiction severity and impulsivity as predictors of treatment completion in substance dependence. Forty-four participants (8 women), between the ages of 19 and 61 years old, who met DSM-IV-TR Axis I substance/alcohol dependence criteria were recruited for the present study. All participants were currently residents at a local substance abuse facility receiving treatment and had been free of all drug toxicity for a minimum of 21 days. The P3 was evoked using a standard rotated-heads oddball paradigm. Significantly reduced P3 amplitude at Pz was found in patients who did not complete treatment compared to those who did. P3 amplitude at Pz elicited by target stimuli correctly identified 76.2% of those who did complete the treatment and 46.7% of those who did not.

Enhanced intensity dependence and aggression history indicate previous regular ecstasy use in abstinent polydrug users

Intensity dependence is an electrophysiological measure of intra-individual stability of the augmenting/reducing characteristic of N1/ P2 event-related potential amplitudes in response to stimuli of varying intensities. Abstinent ecstasy users typically show enhanced intensity dependence and higher levels of impulsivity and aggression. Enhanced intensity dependence and high impulsivity and aggression levels may be due to damage in the brain's serotonergic neurons as a result of ecstasy use. The present study investigated whether intensity dependence, impulsivity and aggression history can be used as indicators of previous chronic ecstasy usage. Forty-four abstinent polydrug users (8 women; age 19 to 61 years old) were recruited. All participants were currently residents at a local substance abuse facility receiving treatment and had been free of all drugs for a minimum of 21 days. The study found significantly enhanced intensity dependence of tangential dipole source activity and a history of more aggressive behavior in those who had previously been involved in chronic ecstasy use. Intensity dependence of the tangential dipole source and aggressive behavior history correctly identified 73.3% of those who had been regular ecstasy users and 78.3% of those who had not. Overall, 76.3% of the participants were correctly classified.

Assessment of impulsive aggression in patients with severe mental disorders and demonstrated violence: inter-rater reliability of rating instrument

Measurements of impulsive and premeditated aggression, developed recently, have been applied to prison and outpatient populations without severe mental disorders. Comparable measures of impulsive and premeditated aggression have not been developed for populations with a severe mental disorder. A practical difficulty is that seriously disturbed, thought-disordered patients are incapable of providing reliable historical information. The investigators adapted the Barratt-Stanford instrument for differentiating impulsive from premeditated aggression so that instead of serving as an interview schedule, it could be used to assess aggression from previously documented written descriptions. The study found that the majority of ratable patients showed predominantly impulsive aggression, and after omitting four weak items, the inter-rater reliability for the determination of impulsive aggression was good (k = 0.53). Far fewer of the patients were determined to have shown predominantly premeditated aggression (from 14.2% to 15.5%) and the inter-rater reliability for premeditated aggression was deemed fair (k = 0.33).

Premeditated aggression is associated with serum cholesterol in abstinent drug and alcohol dependent men

Relationships between aggressive subtypes and lipids were explored in 18 adult males undergoing treatment for substance dependence. A positive association was observed between a measure of premeditated aggression and total cholesterol. This was in contrast to an inverse association between lower cholesterol and higher impulsivity and anxiety.

Comparison of impulsive and premeditated perpetrators of intimate partner violence

Violence occurs in four to five million intimate relationships each year in the United States. Past research has investigated the concept of batterer subtypes based on the nature of the violent behavior. To extend this research, the present study used the Impulsive/Premeditated Aggression Scale (IPAS) along with a battery of relevant self-report measures in a sample of men (N = 113) convicted of domestic violence and court ordered into an intervention program. Batterers whose violence was classified as premeditated scored higher on psychopathic traits and a measure of treatment rejection. Batterers whose violence was classified as impulsive in nature reported a wider range of serious psychopathology. It is suggested that the use of a bimodal classification (Impulsive/Premeditated) in batterers may have significant clinical and legal policy implications.

Characterizing aggressive behavior with the Impulsive/Premeditated Aggression Scale among adolescents with conduct disorder

This study extends the use of the Impulsive/Premeditated Aggression Scale for subtyping aggressive behavior among adolescents with Conduct Disorder. Of the Conduct Disorder symptoms, aggression has the strongest prognostic and treatment implications. While aggression is a complex construct, convergent evidence supports a dichotomy of impulsive and premeditated aggressive subtypes that are qualitatively different from one another in terms of phenomenology and neurobiology. Previous attempts at measuring subtypes of aggression in children and adults are not clearly generalizable to adolescents. Sixty-six adolescents completed a questionnaire for characterizing aggression (Impulsive/Premeditated Aggression Scale), along with standard measures of personality and general functioning. Principal components analysis demonstrated two stable factors of aggression with good internal consistency and construct validity. Compared to the premeditated aggression factor, the impulsive aggression factor was associated with a broader range of personality, thought, emotional, and social problems. As in the adult and child literature, characterization of aggressive behavior into two subtypes appears to be relevant to understanding individual differences among adolescents with Conduct Disorder.

Characterizing aggressive behavior in a forensic population

The concept of a dichotomous versus a continuous aggression model continues to be debated within the research literature. The Impulsive/Premeditated Aggression Scale (IPAS; M. S. Stanford, R. J. Houston, C. W. Mathias, et al., 2003) is a newly developed self-report instrument designed to classify an individual's aggressive behavior as predominantly premeditated or predominantly impulsive. The IPAS consists of 30-items that are scored on a 5-point Likert scale. This study used a nonrandom sample of convenience (N = 85) from a forensic state hospital. Principal-components analysis of the 30 items revealed 2 distinct factors (Impulsive and Premeditated Aggression), which accounted for 33% of the variance. The results of this study further validate the bimodal classification of aggression through its application to a forensic sample. The implications for general assessment, diagnosis, and treatment are discussed.

Latent structure of the Wisconsin Card Sorting Test: a confirmatory factor analytic study

The present study represents the first large scale confirmatory factor analysis of the Wisconsin Card Sorting Test (WCST). The results generally support the three factor solutions reported in the exploratory factor analysis literature. However, only the first factor, which reflects general executive functioning, is statistically sound. The secondary factors, while likely reflecting meaningful cognitive abilities, are less stable except when all subjects complete all 128 cards. It is likely that having two discontinuation rules for the WCST has contributed to the varied factor analytic solutions reported in the literature and early discontinuation may result in some loss of useful information. Continued multivariate research will be necessary to better clarify the processes underlying WCST performance and their relationships to one another.

Electrophysiological substrates of impulsiveness: potential effects on aggressive behavior

Previous investigations attempting to examine impulsiveness as a personality construct are likely confounded with a high incidence of aggressive and antisocial behavior. The present study assessed electroencephalographic activity at rest and during photic stimulation in two groups: (1) an impulsive group (n=10) scoring high on the Barratt Impulsiveness Scale (BIS-11) and reporting no indication of impulsive aggressive behavior; and (2) a non-aggressive control group (n=14) scoring within the normal range on the BIS-11. All subjects completed a brief battery of personality measures related to impulsivity and aggression. Resting EEG was recorded at 9 electrode sites. Photic stimulation was administered at three frequency levels. The primary findings were consistently lower frontal delta and theta activity in the impulsive group as well as a different topographical pattern of beta activity between the groups. These differences appeared to be independent of photic stimulation. Personality analyses indicated significantly greater hostility and lifetime history of aggression in the impulsive group. Taken together, the personality and EEG results suggest some similarity between the present impulsive group and research on groups regularly exhibiting premeditated aggression. These results provide unique insight into the construct of impulsivity and its role in the expression of specific subtypes of aggressive behavior.

A comparison of anticonvulsants in the treatment of impulsive aggression

This study compared the behavioral effects of 3 anticonvulsants in impulsive aggressive men. In a double-blind, placebo-controlled, parallel groups design, participants were randomly assigned to 1 of 4 6-week treatments: phenytoin (n = 7), carbamazepine (n = 7), valproate (n = 7), or placebo (n = 8). The efficacy measure was the average aggression score, a global severity index from the Overt Aggression Scale (J. M. Silver & S. C. Yudofsky, 1991). Analysis showed a significant reduction in impulsive aggression during all 3 anticonvulsant conditions compared with placebo. However, the treatment effect during carbamazepine administration was slightly delayed compared with phenytoin and valproate. These findings suggest that increased use of anticonvulsants could make a significant impact in the control of impulsive aggression in both mental health and criminal justice settings.

The physiological experience of the Paced Auditory Serial Addition Task (PASAT): Does the PASAT induce autonomic arousal?

Previous research suggests that the Paced Auditory Serial Attention Task (PASAT) alters mood states, which may induce performance changes and complicate interpretation test scores. In the current design, we examined arousal as one mechanism moderating PASAT performance. It was expected that arousal level would increase during the test, and performance on the test would be related to arousal level. Heart rate and blood pressure (systolic and diastolic) were recorded from 42 healthy adult men during rest and PASAT challenge. Heart rate and blood pressure were significantly higher and stable across the PASAT procedure, while performance scores showed a steady decrease in correct responses. No association of arousal level and performance was found. Although, PASAT induced arousal changes were not significantly related to performance among healthy adults, the observed arousal changes do raise concerns about interpretation of PASAT performance among more sensitive populations and indicate new areas of application of the procedure.

Obsessive—Compulsive Personality Disorder and Behavioral Disinhibition

Although obsessive-compulsive personality disorder (OCPD) is an Axis II diagnosis that is not commonly associated with behavioral disinhibition, the literature contains reports of occasional explosive aggressive outbursts. Existing explanations of OCPD etiology do not address the coexistence of compulsive and impulsive features witnessed in some subpopulations of patients. In this study, the authors present a compensatory theory of OCPD in an effort to explain clinical observations of an unexpectedly large number of OCPD diagnoses among patients clinic referred and self-referred for aggression problems.

Characterizing aggressive behavior

In the research literature, aggressive behavior has traditionally been classified into two distinct subtypes, impulsive or premeditated. Impulsive aggression is defined as a hair-trigger aggressive response to provocation with loss of behavioral control. Premeditated aggression is defined as a planned or conscious aggressive act, not spontaneous or related to an agitated state. The present study outlines the development of a clinically useful self-report instrument, the Impulsive/Premeditated Aggression Scales (IPAS), designed to characterize aggressive behavior as predominately impulsive or predominately premeditated in nature. The IPAS showed strong reliability and validity. Analysis of the IPASscores demonstrated thepresence of two types of aggressive behavior, impulsive and premeditated, in men referred for anger problems. The aggression of most individuals in the present sample was characterized as predominately impulsive in nature (90%).

The neurobehavioural consequences of St. Louis encephalitis infection

BACKGROUND

St. Louis encephalitis (SLE) is a relatively common cause of neurological illness, yet little is known about its cognitive and psychosocial consequences.

PURPOSE

To describe the cognitive, emotional, psychophysiological, and psychosocial consequences of SLE infection.

METHOD

A comprehensive neuropsychological and psychophysiological evaluation of a high functioning woman 6 weeks and 1 year after acute SLE infection is presented. The focus and course of rehabilitation is also examined.

RESULTS

The primary cognitive consequences of SLE infection involved attention, working memory, speed of processing, and cognitive efficiency. Depression was also observed. Psychometric testing suggested that these deficits largely resolved after 1 year.

CONCLUSIONS

SLE produces neurocognitive deficits which are reflected in both psychometric and psychophysiologic measures and functional status. Psychometric and vocational improvement were observed over 1 year. However, the normal vocational return came at a significant psychosocial cost. This case emphasizes the importance of a comprehensive neuropsychological evaluation and illustrates the importance of an integrated rehabilitation programme.

Antibiotics versus control for toxoplasma retinochoroiditis

BACKGROUND

Acute toxoplasma retinochoroiditis causes transient symptoms of ocular discomfort and may lead to permanent visual loss. Antibiotic treatment primarily aims to reduce the risk of permanent visual loss, recurrent retinochoroiditis, and the severity and duration of acute symptoms. There is uncertainty about the effectiveness of antibiotic treatment.

OBJECTIVES

The objective of this review was to compare the effects of antibiotics versus placebo or no treatment for toxoplasma retinochoroiditis.

SEARCH STRATEGY

We searched the Cochrane Controlled Trials Register - CENTRAL/CCTR, which contains the Cochrane Eyes and Vision Group Specialised Register (Cochrane Library Issue 2, 2001), MEDLINE (1966 to August 2001), EMBASE (1980 to September 2001), Dissertation Abstracts (1861 to June 2001), LILACS (1982 to 1998), Pascal (1984 to March 2000), proceedings of the Association for Research in Vision and Ophthalmology (1980 to 2001), international symposia on uveitis, and reference lists of review articles. Pharmaceutical companies were contacted for unpublished trials.

SELECTION CRITERIA

We included randomised controlled trials that compared any systemic antibiotic treatment against placebo or no treatment. Trials that included immunocompromised patients were excluded.

DATA COLLECTION AND ANALYSIS

The primary outcomes for this review were visual acuity at least three months after treatment and risk of recurrent retinochoroiditis. Secondary outcomes were improvement in symptoms and signs of intraocular inflammation, size of lesion and adverse events. Effect measures were pooled using a random effects model.

MAIN RESULTS

Three trials, which randomised a total of 173 participants, met the inclusion criteria. All trials were methodologically poor. None reported the effect of treatment on visual acuity. Two studies reported results for recurrent retinochoroiditis: one (124 participants) found a significant reduction in participants with chronic recurrent disease who were treated for 14 months: relative risk 0.28 (95% confidence interval 0.10 to 0.78); the other (20 participants) found no evidence of an effect in participants with acute toxoplasma retinochoroiditis (relative risk 1.00, 95% confidence interval 0.07 to 13.87). Two studies reported an improvement in intraocular inflammation in treated compared with untreated participants and one study reported no difference. Two studies found an increased risk of adverse events in treated participants.

REVIEWER'S CONCLUSIONS

There is a lack of evidence to support routine antibiotic treatment for acute toxoplasma retinochoroiditis. There is weak evidence to suggest that long-term treatment of patients with chronic recurrent toxoplasma retinochoroiditis may reduce recurrence. Placebo controlled trials of patients with acute and chronic toxoplasma retinochoroiditis affecting any part of the retina are required to determine the effectiveness of antibiotic treatment.