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.     

Assessment of Past Aggression: Examination of the Convergent Validity of Three Instruments

Assessing an individual's history of aggression is a common task in clinical and forensic mental health practice. Although several methods for quantifying aggression are available, the extent to which they yield comparable results is unclear. The aim of this study was to explore the convergent validity of three instruments assessing past aggression and violence (the Life History of Aggression, Aggression Scale [LHA-A], the Violence Rating Scale [VRS] and the Cormier–Lang System for Quantifying Criminal History–Violence Offences Index [CL-V]) using 87 offenders undergoing pre-sentence psychological and/or psychiatric evaluations for the criminal courts in Victoria, Australia. A frequency count of all violent offences recorded on official criminal records was also completed. Correlational analyses were used to explore the associations between the different indices. Results demonstrated convergent validity of the instruments, but suggest that the LHA-A most reliably quantifies the severity and frequency of past aggression.     

Assessing the reliability,predictive and construct validity of historical,clinical and risk management-20 (HCR-20) in Mexican psychiatric inpatients

Introduction: Assessing dangerousness to gauge the likelihood of future violent behaviour has become an integral part of clinical mental health practice in forensic and non-forensic psychiatric settings, one of the most effective instruments for this being the Historical, Clinical and Risk Management-20 (HCR-20). Objective: To examine the HCR-20 factor structure in Mexican psychiatric inpatients and to obtain its predictive validity and reliability for use in this population. Method: In total, 225 patients diagnosed with psychotic, affective or personality disorders were included. The HCR-20 was applied at hospital admission and violent behaviours were assessed during psychiatric hospitalization using the Overt Aggression Scale (OAS). Construct validity, predictive validity and internal consistency were determined. Results: Violent behaviour remains more severe in patients classified in the high-risk group during hospitalization. Fifteen items displayed adequate communalities in the original designated domains of the HCR-20 and internal consistency of the instruments was high. Conclusion: The HCR-20 is a suitable instrument for predicting violence risk in Mexican psychiatric inpatients.     

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.     

A STUDY OF AGGRESSION AMONG REFERRALS TO A COMMUNITY-BASED PSYCHIATRY OF OLD AGE SERVICE

Objective. The aims of the study were to examine the prevalence of aggressive behaviour in a non-selected community-based population, to identify clinical and sociodemographic variables associated with aggression and to examine the relationship between aggression and outcome at 2-year follow-up. Design. Case series, using the Ryden Aggression Scale as a retrospective measure of aggression. Setting. A community-based specialist psychiatry of old age service. Participants. All referrals to the service over a 3-month period. Results. Of the 42 subjects included in the study, 25 patients had a diagnosis of dementia. Aggressive behaviour was reported in 18 patients, this being verbal only in nine cases and both verbal and physical in nine cases. Sexual aggression and self-injurious behaviour were each reported in one case only. Aggression was found to be positively associated with a diagnosis of dementia and high physical dependency but was not found to be associated with age, sex, physical illness or the use of psychotropic medication. At 2-year follow-up, aggressive patients were found to have a higher rate of admission to psychiatric inpatient or residential care and tended to have a higher use of neuroleptic drugs. Conclusions. These findings suggest that aggression is a significant problem for community-based elderly people and their carers, may increase the likelihood of admission into long-term care and that a reliable instrument to measure aggression would be useful in the clinical assessment of this population. © 1997 by John Wiley & Sons, Ltd.     

Self-harm as a risk factor for inpatient aggression among women admitted to forensic psychiatric care

Background: Inpatient aggression among female forensic psychiatric patients has been shown to be associated with self-harm, that is considered to be a historical risk factor for violence. Research on associations between previous or current self-harm and different types of inpatient aggression is missing.

Aim: The aim of this register study was to investigate the prevalence of self-harm and the type of inpatient aggression among female forensic psychiatric inpatients, and to study whether the patients’ self-harm before and/or during forensic psychiatric care is a risk factor for inpatient aggression.

Methods: Female forensic psychiatric patients (n?=?130) from a high security hospital were included.

Results: The results showed that 88% of the female patients had self-harmed at least once during their life and 57% had been physically and/or verbally aggressive towards staff or other patients while in care at the hospital. Self-harm before admission to the current forensic psychiatric care or repeated self-harm were not significantly associated with inpatient aggression, whereas self-harm during care was significantly associated with physical and verbal aggression directed at staff.

Conclusions: These results pointed towards self-harm being a dynamic risk factor rather than a historical risk factor for inpatient aggression among female forensic psychiatric patients. Whether self-harm is an individual risk factor or a part of the clinical risk factor ‘Symptom of major mental illness’ within the HCR-20V3 must be further explored among women. Thus, addressing self-harm committed by female patients during forensic psychiatric care seems to be important in risk assessments and the management of violence, especially in reducing violence against staff in high-security forensic psychiatric services.     

A self-report version of the Ways of Responding: Reliability and validity in a clinical sample

Objective: The Ways of Responding (WOR) instrument measures compensatory skills, a central construct in some theories of the mechanism of cognitive therapy for depression. However, the instrument is time-consuming and expensive to use in community settings, because it requires trained independent judges to rate subjects’ open-ended written responses to depressogenic scenarios. The present study evaluated the reliability and validity of a self-report version of the WOR (WOR-SR) in a community mental health sample with depressive symptoms (N?=?467). Method: Subjects completed the WOR-SR, a modified version of the original WOR, and other measures of depressive symptoms, dysfunctional cognitions, functioning, quality of life, and interpersonal problems at multiple time points. Results: An exploratory factor analysis confirmed the two-factor structure of the WOR-SR. The positive and negative subscales both demonstrated excellent internal consistency (Cronbach’s alphas?=?.91) and moderate convergent validity with other measures. Conclusion: The WOR-SR is a reliable and valid measure of compensatory skills in patients receiving treatment for depression at community mental health centers.     

Small amygdala – high aggression? The role of the amygdala in modulating aggression in healthy subjects

Objective. Several lines of evidence suggest an association between the amygdala and the modulation of aggressive behaviour. Previous morphometric brain imaging studies have focused on the role of the amygdala in the context of pathologic neuropsychiatric conditions like depression, personality disorders, and dysphoric and aggressive behaviour in epilepsy. In order to better understand the physiological role of the amygdala in modulating aggressive behaviour we investigated the relationship between amygdala volumes and lifetime aggression in healthy subjects. Methods. Morphometric brain scans were obtained in 20 healthy volunteers. Amygdala volumes were measured by manually outlining the boundaries of the structure following a well established and validated protocol. Careful psychiatric and psychometric assessment was done to exclude any psychiatric disorder and to assess lifetime aggressiveness with an established and validated psychometric instrument (i.e. Life History of Aggression Assessment (LHA)). Results. All volunteers scored in the normal range of lifetime aggression. Volunteers with higher aggression scores displayed a 16–18% reduction of amygdala volumes. There was a highly significant negative correlation between amygdala volumes and trait aggression. Conclusion. The extent of volumetric differences in this study is remarkable and suggests that amygdala volumes might be a surrogate marker for the personality property of aggressiveness in healthy human beings.     

Proactive, reactive, and romantic relational aggression in adulthood: Measurement, predictive validity, gender differences, and association with Intermittent Explosive Disorder

The psychometric properties of a recently introduced adult self-report of relational aggression are presented. Specifically, the predictive utility of proactive and reactive peer-directed relational aggression, as well as romantic relational aggression, are explored in a large (N = 1387) study of adults. The measure had adequate reliability and validity and the subscales demonstrated unique predictive abilities for a number of dependent variables. In particular, reactive but not proactive relational aggression was uniquely associated with history of abuse, hostile attribution biases, and feelings of distress regarding relational provocation situations. Reactive relational aggression was also more strongly related to anger and hostility than proactive aggression. In addition, relational aggression in the context of romantic relationships was uniquely related to anger, hostility, impulsivity, history of abuse, hostile attribution biases, and emotional sensitivity to relational provocations, even when controlling for peer-directed relational aggression. Gender differences in overall levels of relational aggression were not observed; however, males were most likely to engage in peer-directed proactive and reactive relational aggression whereas females were most likely to engage in romantic relational aggression. In a second study (N = 150), relational aggression was higher in a sample of adults with Intermittent Explosive Disorder than in a sample of healthy controls or psychiatric controls. The findings highlight the importance of assessing subtypes of relational aggression in adult samples. Ways in which this measure may extend research in psychology and psychiatry are discussed.     

Further Validation of a Measure of Proactive and Reactive Aggression Within a Clinical Child Population

The current study provided further validity for the use of a measure of proactive and reactive aggression that was first developed by Little and his colleagues. Confirmatory factor analyses performed with a high-risk clinical population (N = 107) revealed that the model was a good fit to the data. Structural equation models revealed significant associations in the expected direction between the Little et al. measure and another measure of proactive and reactive aggression developed by Dodge and Coie. Further analyses revealed that the proactive aggression subscales of the Little et al. and Dodge and Coie measures were significantly related to conduct problems. However, the reactive aggression subscale of the Little et al. measure was not related to social problems while both the proactive and reactive aggression subscales of the Dodge and Coie measure were.     

Childhood traumas in euthymic bipolar disorder patients in Eastern Turkey and its relations with suicide risk and aggression

Abstract

Purpose: The aim of this study was to determine the relationship between childhood trauma and aggression-suicidal behavior in patients with bipolar disorder.

Material and Methods: A total of 112 outpatients diagnosed with bipolar disorder in remission in the province of Siirt on the east coast of Turkey were included in this study carried out between January and June 2018. Personal Information Form, Childhood Trauma Questionnaire (CTQ), Buss–Perry Aggression Scale (BPAS) and Suicide Probability Scale (SPS) were used for data acquisition.

Results: It was determined that patients with bipolar disorder have 89.3% of physical neglect, 74.1% of emotional neglect, 75.9% of physical abuse, 79.5% of emotional abuse and 40.2% of sexual abuse. The mean score of CTQ was 66.8?±?19.2, the total score of BPAS was 94.6?±?28.8 and the total score of SPS was 85.3?±?17.9. A statistically significant and positive correlation was determined between CTQ, BPAS and SPS (p?<?0.05).

There was a weak and positive relationship between BPAS, CTQ (r?=?0.325**; p?<?0.05) and subscales of CTQ which are emotional abuse (r?=?0.350**; p?<?0.05), physical abuse (r?=?0.354**; p?<?0.01), physical neglect (r?=?0.313**; p?<?0.01) and emotional neglect (r?=?0.316**; p?<?0.01). A statistically significant difference was observed between the regular use of drugs, violence against others and total score of CTQ, BPAS and SPS (p?<?0.05).

Conclusion: It is suggested that patients diagnosed with bipolar disorder should be evaluated with regards to childhood trauma history by taking into consideration sociodemographic characteristics and psychiatric support in order to prevent their aggression and suicide attempts.     

Impulsive and premeditated aggression: a factor analysis of self-reported acts.

Although aggression research in general has been hampered by a lack of objective measurements of aggressive acts, two types of aggressive acts, impulsive vs. premeditated, have been studied extensively in recent years. These two types of aggression have been primarily measured by structured or semi-structured interviews. The current study was designed to assess the construct validity of these two types of aggression using a self-report questionnaire which included items gleaned from the content of interviews used in past studies. For this study, 216 college students assessed their own aggressive acts rather than answering general questions about aggression. The students were not significantly different from normative sample groups on self-report measures of impulsiveness, aggression, and anger/hostility. A PCA factor analysis with a promax rotation of the items on the self-report questionnaire identified four factors: impulsive aggression; mood on the day the act occurred; premeditated aggression; and agitation. Thus, impulsive and premeditated aggression are independent constructs which exist in varying degrees among these 'normal' persons in a non-clinical sample. Impulsive aggression was characterized in part by feelings of remorse following the acts and by thought confusion. Premeditated aggression was related to social gain and dominance.     

Development and psychometric evaluation of a Japanese scale to assess depression severity: Himorogi Self-Rating Depression Scale

Abstract

Objective. The 17-item Hamilton Rating Scale for Depression (HAMD-17) is the most widely used instrument to assess depression severity, but it has a number of limitations in clinical use. There is no depression scale designed for Japanese culture that has been shown to be valid. This study aimed to develop a Japanese depression scale, the Himorogi Self-rating Depression Scale (HSDS), and to assess psychometric properties of it. Methods. Data were collected using the HSDS and the HAMD-17 from 204 outpatients of psychiatric clinics. Follow-up data were collected three times with an interval of at least 4 weeks, and reliability and validity were longitudinally observed. Results. Principal component analysis found a uni-factorial nature for both scales. The HSDS indicated stronger factor coefficients and a larger variance than the HAMD-17. ROC analysis showed high ability to distinguish between the presence and absence or remission of depression. High convergent validity and reliability coefficients were consistently indicated. Conclusions. Although the convenience sample restricts generalisability of the findings and only a single instrument was used as a standard for comparison, reliability and validity for the HSDS was supported. The HSDS is suggested as a substitute for the HAMD-17 in clinical use.     

Aggression in the general Swedish population, measured with a new self-rating inventory: The Aggression Questionnaire--revised Swedish version (AQ-RSV)

The aim of the present study was to develop a Swedish self-rating instrument for clinical aggression research based on the American Aggression Questionnaire (AQ), which measures physical aggression, verbal aggression, anger, and hostility. To test this adapted Aggression Questionnaire--revised Swedish version (AQ-RSV), it was mailed to 781 randomly selected individuals, aged 20-40 year. A total of 497 (64%) evaluable AQ-RSV inventories were obtained and analyzed statistically. Drop-out analysis showed that non-responders were most often male and significantly older than responders. Among the responders, AQ-RSV showed significant sex differences in all aggression subscales except Hostility. Aggression was found to vary with age, geographical region, and size of home community. The AQ and the AQ-RSV were comparable in correlations between the four aggression subscales and in alpha coefficients, which indicated considerable internal consistency. Development of the aggression-measuring instrument for Swedish conditions is important not only to study subtraits of aggression but to enable analyses of their relationships to neurobiological and psychiatric variables.     

Aggression in the general Swedish population,measured with a new self-rating inventory: The Aggression Questionnaire - revised Swedish version (AQ-RSV)

The aim of the present study was to develop a Swedish self-rating instrument for clinical aggression research based on the American Aggression Questionnaire (AQ), which measures physical aggression, verbal aggression, anger, and hostility. To test this adapted Aggression Questionnaire - revised Swedish version (AQ-RSV), it was mailed to 781 randomly selected individuals, aged 20-40 year. A total of 497 (64%) evaluable AQ-RSV inventories were obtained and analyzed statistically. Drop-out analysis showed that non-responders were most often male and significantly older than responders. Among the responders, AQ-RSV showed significant sex differences in all aggression subscales except Hostility. Aggression was found to vary with age, geographical region, and size of home community. The AQ and the AQ-RSV were comparable in correlations between the four aggression subscales and in alpha coefficients, which indicated considerable internal consistency. Development of the aggression-measuring instrument for Swedish conditions is important not only to study subtraits of aggression but to enable analyses of their relationships to neurobiological and psychiatric variables.     

Brief Rating of Aggression by Children and Adolescents (BRACHA): development of a tool for assessing risk of inpatients' aggressive behavior

This study evaluated the Brief Rating of Aggression by Children and Adolescents-Preliminary Version (BRACHA 0.8), an actuarial method of assessing the risk of aggressive behavior by hospitalized children and adolescents. Licensed psychiatric social workers used a 16-item questionnaire to assess all patients seen in the emergency department (ED) of a major urban children's hospital. Over a six-month period, 418 patients (age range, 3.5-19.0 years) underwent psychiatric hospitalization after ED evaluation. The hospital nursing staff recorded the inpatients' behavior, with the Overt Aggression Scale (OAS). Inpatients were deemed aggressive if, during the first six days of their hospital stay, they scored one or higher on any OAS subscale. We evaluated questionnaire properties, items, and demographic covariates (e.g., age, sex, and living situation) by using factor analyses, logistic regression models, and receiver operating characteristic (ROC) methods. A total of 292 aggressive acts were committed by 120 (29% of 418) patients. Fourteen of the 16 items predicted (p < .007) inpatient aggression and showed good internal consistency (Cronbach's α = 0.837). Age was inversely related to probability of aggression and was incorporated into the final assessment instrument. Predictive power was comparable with other published risk assessment instruments (ROC areas of .75 for any aggression and .82 for aggression toward others). BRACHA 0.8 shows promise in rapidly assessing risk of inpatient aggression, but further studies are needed to establish the reliability and validity of the instrument.     

Delinquency and criminal offenses in former schizophrenic inpatients 7–12 years following discharge

Abstract. Background: Previously, we reported a high prevalence of aggression in a large sample of schizophrenic patients treated between 1990–1995 in the psychiatric hospital of the University of Munich. Aims: To assess the prevalence of criminal offences and delinquency in former schizophrenic inpatients following discharge. Method: With permission of the German General Attorney we reviewed the national criminal register records of criminal offences of these patients for a 7–12 year period following discharge. Results: 224 (13.1%) of the 1705 patients had been convicted in the 7–12 year post discharge period. Male patients (22.1%) outnumbered female patients (6.9 %) 3:1 in this respect. The rate for violent offences was especially high: 45 (2.6 %) of the sample were convicted for physical injury offences (68 cases). Five cases of attempted or completed manslaughter or murder were recorded. Conclusions: These data indicate a significant rate of delinquency and serious physical injuries in former schizophrenic inpatients. Future research may try to identify risk factors for aggression and violence in schizophrenic patients.     

The Behavior Problems Inventory: An Instrument for the Assessment of Self-Injury, Stereotyped Behavior, and Aggression/Destruction in Individuals with Developmental Disabilities

The Behavior Problems Inventory (BPI-01) is a 52-item respondent-based behavior rating instrument for self-injurious, stereotypic, and aggressive/destructive behavior in mental retardation and other developmental disabilities. Items are rated on a frequency scale and a severity scale. The BPI-01 was administered by interviewing direct care staff of 432 randomly selected residents from a developmental center between the ages of 14 to 91 years. For 73% of those selected, at least one problem was endorsed on the BPI-01. A total of 43% showed self-injury, 54% stereotyped behavior, and 38% aggressive/destructive behavior. Confirmatory factor analysis and item-total correlations supported the three a priori factors. Analyses of variance (ANOVA) showed that of the variables age, sex, and level of mental retardation, only the latter had a significant effect on the BPI-01 total score, the SIB subscale score, and the Stereotyped Behavior subscale score. Aggression/destruction was not significantly related to any of the three variables. Individuals with a diagnosis of pervasive developmental disorder had higher scores on all three subscales than those without, whereas residents with a diagnosis of stereotyped movement disorder had higher Stereotyped Behavior scale scores than those without. The BPI-01 was found to be a reliable (retest reliability, internal consistency, and between-interviewer-agreement) and valid (factor and criterion validity) behavior rating instrument for problem behaviors in mental retardation and developmental disabilities with a variety of potentially useful applications. Strengths and limitations of the instrument are discussed.     

Adult Attention Deficit Disorder and Aggressive Behaviour: An Exploration of Relationships between Brown Attention-Deficit Disorder Scales and the Aggression Questionnaire

Aggressive and violent behaviour is often associated with a diagnosis of attention-deficit hyperactivity disorder (ADHD). This article investigates the relationship between adult attention deficit disorder (ADD) and aggressive cognitions. The Aggression Questionnaire and the Brown Attention-Deficit Disorder Scales were administered to two samples: a “low-risk sample” comprising university students (n = 60), and a “high-risk sample” of prison inmates (n = 117). The prevalence of “probable ADD” was found to be higher in the prison sample (33%), compared with the university sample (20%). There were moderate correlations >r = .5 (p < .01) between total ADHD and Aggression Questionnaire scores in both groups. There were also moderate to strong correlations between subscales of both measures, including cognitive processes such as attention and memory and various forms of aggression, which were particularly apparent in the prison sample. The relationship between ADHD and aggressive behaviour suggests that the treatment of adult ADHD may aid in the management of aggressive behaviour.