Measuring victim empathy among mentally disordered offenders: Validating VERA-2

There are very few, if any, valid and victim-specific situation empathy measures available at present for use with mentally disordered offenders. The aim of this study was to validate a modified version (VERA-2) of the Victim Empathy Response Assessment (VERA) tool which was developed earlier (Young et al., 2008) to enable victim-specific situation empathy measurement in offenders. A total of 55 mentally disordered in-patients residing in a maximum security hospital were assessed on VERA-2 as well as on measures of antisocial personality traits, global affective empathy, violent cognitions, and reported remorse for the index offence. The VERA-2 cognitive and affective empathy scales were negatively correlated with antisocial personality traits and violent cognitions, and positively related to remorse for the index offence. Global affective empathy was positively related to VERA-2 affective empathy. Participants with a history of sexual offending had significantly higher cognitive empathy than other offenders. Acceptance of violence and remorse for the index offence were the best predictors of both cognitive and affective empathy. The findings suggest that the VERA-2 is a valid instrument for measuring victim empathy among mentally disordered offenders, and may prove useful in the context of future risk assessment and outcomes in this population.     

Brief report: The Adolescent Child-to-Parent Aggression Questionnaire: An examination of aggressions against parents in Spanish adolescents

The objective of this study was to develop a questionnaire to assess child-to-parent aggression in adolescents and to document the extent of the problem. The questionnaire developed in this study, the Child-to-Parent Aggression Questionnaire (CPAQ), includes forms of physical and psychological aggression directed at both the mother and the father. It also includes open questions about the reasons for the aggressive acts. The CPAQ was completed by a sample of 2719 adolescents (age range: 13–18 years old, 51.4% girls). Confirmatory factor analysis supported a four-factor correlated structure (physical aggression against mother, physical aggression against father, psychological aggression against mother, and psychological aggression against father). Psychological and physical aggression against the mother was more frequent than against the father. However, there were no differences with regard to severe forms of aggression. Girls scored significantly higher on all indicators of psychological aggression, including severe psychological aggression. Nevertheless, except for the prevalence of physical aggression against mothers, which was higher in females, there were no significant differences in physical aggression against parents. Finally, the reasons provided by the adolescents for the aggression included both instrumental (e.g., to obtain permission to get home late and to access their computers) and reactive reasons (e.g., anger and self-defense). These findings highlight the complexity of child-to-parent aggression in adolescence.     

Nurses’ perceptions of the factors which cause violence and aggression in the emergency department: A qualitative study

There has been an increase in violence and aggression in emergency departments (EDs) in recent years. Among professional health care workers, nurses are more likely than other staff members to be involved in aggressive incidents with patients or relatives. This research study was undertaken to determine nurses’ perceptions of the factors that cause violence and aggression in the ED. Using a qualitative approach, twelve nurses working in an Irish ED were interviewed. Thematic analysis of the interview data revealed that environmental and communication factors contributed to violence and aggression in the ED. Participants perceived waiting times and lack of communication as contributing factors to aggression, and triage was the area in the ED where aggression was most likely to occur. A number of key recommendations arise from the study findings and they all relate to communication. To address the aggression that may arise from waiting times, electronic boards indicating approximate waiting times may be useful. Also, information guides and videotapes on the patient’s journey through the ED may be of benefit. Consideration to the appointment of a communication officer in the ED and communication training for ED staff is also recommended.     

护士工作场所暴力流行病学研究

目的探讨护士工作场所暴力的流行病学特征,为有效预防与控制工作场所暴力提供科学依据。方法整群与分层抽样相结合,调查广东省所属广州、揭阳、深圳和东莞4市医院在职护士工作场所暴力发生情况,采用频数分析和Logistic回归等统计方法对资料进行处理。结果被调查到的3319名护士在过去的一年中有2085人遭受过工作场所暴力,个别护士甚至因暴力伤害而致残或遭受强奸（含未遂）,暴力的年发生率为62．82％,其中心理暴力为62．07％,身体暴力为15．06％。暴力多发生在急诊科或住院部各科室,科室内部以病房和护士站最常见,近1／3的暴力事件发生在晚依班。男性护士比女性护士更容易遭受暴力伤害,小于40岁年龄段护士是工作场所暴力的高危人群。受访者认为传媒在暴力防治过程中起重要作用。结论护士工作场所暴力问题严重,正逐渐成为一种职业伤害。护士个人、医院、政府以及社会传媒应共同努力,消除暴力隐患,尽量减少和避免护士工作场所暴力发生。     

Meeting Highlights on Psychosis and Schizophrenia: The 3 Annual Chair Summit

The Institute of Medicine report Redesigning Continuing Education in the Health Professions (2010) calls for CME to align learning with health professionals’ needs. To meet that goal, The 3rd Annual Chair Summit, The Master Class for Neuroscience Professional Development, held in Chicago, Illinois (August 2010), brought together chairpersons in psychiatry and neurology to act as expert peer teachers for frontline clinician learners. Faculty and learners collaboratively evaluated evidence, shared ideas and clinical practice challenges, developed individualized clinical strategies, explored the role of the multidisciplinary team, discussed health-system issues, and translated the neuroscience discoveries into patient-centered practice improvements. This third article in the CME-certified companion series, “Meeting Highlights of the 3^rd Annual Chair Summit, The Master Class for Neuroscience Professional Development, 2010,” will analyze plenary and breakout educational sessions on psychosis and schizophrenia genetic research, clinical research, and patient care. Highlights of the important issues related to management of psychosis and extreme or violent situations are discussed. Two clinical case challenges help cement previous learning and encourage readers to consider management options and sketch out patient-centered, tailored treatment plans. Summary points connecting research to clinical practice for each topic are also presented.     

Vers une déconstruction des situations de maltraitances intrafamiliales

This article discusses intrafamily abuse under judicial control, the category of violent and sexual offenses against children. More specifically, it deals with the acting abuse's functional signification in family. Differents levels of analysis are questioned: situations and contexts in which the actions arrive, the author positions the married couple and parental and family functioning mode. These fields are investigate in an economic dynamics and axiological's perspective. The complexity of the situations is illustrated by the presentation of three clinical cases. This article opens lines for understanding the abuse's situations by a dynamic model.     

Training of affect recognition in schizophrenia patients with violent offences: Behavioral treatment effects and electrophysiological correlates

Violent offenders with schizophrenia have a particularly poor performance level in facial affect recognition.

Nineteen male schizophrenia patients, who had been committed to psychiatric hospital detention because of violent offences and lack of criminal responsibility, were recruited to receive the Training of Affect Recognition (TAR). Performance in the Pictures of Facial Affect (PFA)-test and event-related potentials (ERPs) were registered in a pre–post-treatment design.

TAR was feasible with a very high treatment effect (Cohen’s d = 1.88), which persisted for 2 months post-treatment. ERPs remained unchanged post- vs. pre-treatment, while low resolution brain electromagnetic tomography (LORETA) revealed activation decreases in left-hemispheric parietal–temporal–occipital regions at 172 msec and activation increases in right dorsolateral prefrontal cortex and anterior cingulate at 250 msec.

Possibly, violent offenders with schizophrenia are particularly amenable to TAR because of a high level of dysfunction at baseline. Post- vs. pre-treatment changes of neural activity (LORETA) may mirror a gain of efficiency in structural face decoding and a shift towards a more reflective mode of emotional face decoding, relying on increased frontal brain activity. Functional magnetic resonance imaging (BOLD-fMRI) -data from another study further supports this notion. TAR treatment might enable subjects with schizophrenia and a disposition to violence to reach a higher degree of deliberation of their reactive behavior to facial affect stimuli.