Psychiatric Patients with a Serious Mental Illness and a Recent History of Violent Behavior: An Exploration of Developmental, Clinical, Cognitive, and Demographic Characteristics

Author(s): Jill Del Pozzo*, Lindsay Cherneski, Saul J. Beck, Sarah R. Lowe, Steven M. Silverstein

Journal Name: Current Psychiatry Research and Reviews
Formerly Current Psychiatry Reviews

Volume 16 , Issue 2 , 2020


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Graphical Abstract:


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.

Keywords: Schizophrenia, violence, psychosis, psychopathy, trauma, violence risk.

[1]
Fazel S, Gulati G, Linsell L, Geddes JR, Grann M. Schizophrenia and violence: systematic review and meta-analysis. PLoS Med 2009; 6(8)e1000120
[http://dx.doi.org/10.1371/journal.pmed.1000120] [PMID: 19668362]
[2]
Volavka J. Violence in schizophrenia and bipolar disorder Psychiatria danubina 2013; 1325(1): 0-33.
[3]
Silverstein SM, Del Pozzo J, Roché M, Boyle D, Miskimen T. Schizophrenia and violence: realities and recommendations. Crime Psychol Rev 2015; 1(1): 21-42.
[http://dx.doi.org/10.1080/23744006.2015.1033154]
[4]
Swanson JW, Holzer CE III, Ganju VK, Jono RT. Violence and psychiatric disorder in the community: evidence from the Epidemiologic Catchment Area surveys. Hosp Community Psychiatry 1990; 41(7): 761-70.
[http://dx.doi.org/10.1176/ps.41.7.761] [PMID: 2142118]
[5]
Douglas KS, Guy LS, Hart SD. Psychosis as a risk factor for violence to others: a meta-analysis. Psychol Bull 2009; 135(5): 679-706.
[http://dx.doi.org/10.1037/a0016311] [PMID: 19702378]
[6]
Elbogen EB, Johnson SC. The intricate link between violence and mental disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry 2009; 66(2): 152-61.
[http://dx.doi.org/10.1001/archgenpsychiatry.2008.537] [PMID: 19188537]
[7]
Monahan J. Rethinking risk assessment: The MacArthur study of mental disorder and violence. New York: Oxford University Press 2001.
[8]
Thompson JL, Kelly M, Kimhy D, et al. Childhood trauma and prodromal symptoms among individuals at clinical high risk for psychosis. Schizophr Res 2009; 108(1-3): 176-81.
[http://dx.doi.org/10.1016/j.schres.2008.12.005] [PMID: 19174322]
[9]
Bonoldi I, Simeone E, Rocchetti M, et al. Prevalence of self-reported childhood abuse in psychosis: a meta-analysis of retrospective studies. Psychiatry Res 2013; 210(1): 8-15.
[http://dx.doi.org/10.1016/j.psychres.2013.05.003] [PMID: 23790604]
[10]
Şahin S, Yüksel Ç, Güler J, et al. The history of childhood trauma among individuals with ultra high risk for psychosis is as common as among patients with first-episode schizophrenia. Early Interv Psychiatry 2013; 7(4): 414-20.
[http://dx.doi.org/10.1111/eip.12022] [PMID: 23343404]
[11]
Falukozi E, Addington J. Impact of trauma on attenuated psychotic symptoms. Psychosis 2012; 4(3): 203-12.
[http://dx.doi.org/10.1080/17522439.2011.626867] [PMID: 23155365]
[12]
Kline E, Millman ZB, Denenny D, et al. Trauma and psychosis symptoms in a sample of help-seeking youth. Schizophr Res 2016; 175(1-3): 174-9.
[http://dx.doi.org/10.1016/j.schres.2016.04.006] [PMID: 27107632]
[13]
Gillikin C, Habib L, Evces M, Bradley B, Ressler KJ, Sanders J. Trauma exposure and PTSD symptoms associate with violence in inner city civilians. J Psychiatr Res 2016; 83: 1-7.
[http://dx.doi.org/10.1016/j.jpsychires.2016.07.027] [PMID: 27518177]
[14]
Collins JJ, Bailey SL. Traumatic stress disorder and violent behavior. J Trauma Stress 1990; 3(2): 203-20.
[http://dx.doi.org/10.1002/jts.2490030204]
[15]
Swanson JW, Swartz MS, Van Dorn RA, et al. A national study of violent behavior in persons with schizophrenia. Arch Gen Psychiatry 2006; 63(5): 490-9.
[http://dx.doi.org/10.1001/archpsyc.63.5.490] [PMID: 16651506]
[16]
Steadman HJ, Mulvey EP, Monahan J, et al. Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighborhoods. Arch Gen Psychiatry 1998; 55(5): 393-401.
[http://dx.doi.org/10.1001/archpsyc.55.5.393] [PMID: 9596041]
[17]
Abushua’leh K, Abu-Akel A. Association of psychopathic traits and symptomatology with violence in patients with schizophrenia. Psychiatry Res 2006; 143(2-3): 205-11.
[http://dx.doi.org/10.1016/j.psychres.2005.05.017] [PMID: 16879872]
[18]
Holdnack HA. Wechsler test of adult reading: WTAR. Texas: The Psychological Corporation 2001.
[19]
First MB, Spitzer RL, Williams JB, Gibbon M. Structured Clinical Interview for DSM IV-Patient Edition (SCID-P). Washington, DC: American Psychiatric Press 1995.
[20]
Loranger AW. International Personality Disorders Examination Screening Questionnaire DSM-IV module North Florida. Psychological Assessment Resources 1999.
[21]
Bechara A, Damasio AR, Damasio H, Anderson SW. Insensitivity to future consequences following damage to human prefrontal cortex. Cognition 1994; 50(1-3): 7-15.
[http://dx.doi.org/10.1016/0010-0277(94)90018-3] [PMID: 8039375]
[22]
Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 1987; 13(2): 261-76.
[http://dx.doi.org/10.1093/schbul/13.2.261] [PMID: 3616518]
[23]
Blake DD, Weathers FW, Nagy LM, et al. The development of a clinician-administered PTSD scale. J Trauma Stress 1995; 8(1): 75-90.
[http://dx.doi.org/10.1002/jts.2490080106] [PMID: 7712061]
[24]
Weathers FW, Litz BT, Herman DS, Huska JA, Keane TM. The PTSD Checklist (PCL): Reliability, validity, and diagnostic utility. Inannual convention of the international society for traumatic stress studies 1993. Vol. 462(24).
[25]
Applebay L, Baxter D, Appleby L, et al. Manual for the Psychopathy Checklist: Screening Version (PCL: SV)
[26]
Webster CD, Douglas KS, Eaves D, Hart SD. HCR-20: Assessing risk for violence (Version 2). Mental Health. Law, and Policy Institute, Simon Fraser University: Canada 1997.
[27]
Webster CD, Eaves D. The HCR-20 scheme: The assessment of dangerousness and risk. Mental Health, Law and Policy Institute, Department of Psychology, Simon Fraser University and Forensic Psychiatric Services Commission of British Columbia 1995.
[28]
Ibm CR. IBM SPSS Statistics for Windows, Version Q3 250 Armonk, NY: IBM Corp. 2017.
[29]
Swanson JW, Swartz MS, Van Dorn RA, et al. CATIE investigators. Comparison of antipsychotic medication effects on reducing violence in people with schizophrenia. Br J Psychiatry 2008; 193(1): 37-43.
[http://dx.doi.org/10.1192/bjp.bp.107.042630] [PMID: 18700216]
[30]
Mueser KT, Gottlieb JD, Xie H, et al. Evaluation of cognitive restructuring for post-traumatic stress disorder in people with severe mental illness. Br J Psychiatry 2015; 206(6): 501-8.
[http://dx.doi.org/10.1192/bjp.bp.114.147926] [PMID: 25858178]


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Article Details

VOLUME: 16
ISSUE: 2
Year: 2020
Published on: 25 April, 2020
Page: [110 - 118]
Pages: 9
DOI: 10.2174/2666082216999200425222601
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