Infection during childhood and the risk of violent criminal behavior in adulthood

Infections during brain development appear to contribute to cognitive impairment and aggressive behavior, as well as to a number of developmental mental disorders closely associated with violent criminal behavior. Yet, no study has thus far ever investigated whether infections during brain development increases the risk of violent criminality later in life.In this population-based cohort study, about 2.2 million individuals born in Sweden between the years 1973 and 1995 were included in an effort to estimate the association between infections during childhood (registered ICD-10 diagnoses of infections incurred before the age of 14 years) and violent criminal behavior (registered convictions for a violent crime between the ages of 15 and 38 years, prior to December 31, 2011). After inclusion of several sociodemographic parameters, risks of violent criminal behavior conferred by childhood infections – expressed as hazard ratios (HRs) and 95% confidence intervals (CIs) – were calculated by means of Cox regression. Mediation analyses were performed to explore the effect of psychiatric disorders on the association between infections during childhood and violent criminality. Results revealed a modest, yet significant, association between an infection during childhood and violent criminality later in life (adjusted HR 1.14, 95% CI 1.12–1.16). Infections during the first year of life and infections in the central nervous system were associated with the highest risks of subsequent violent criminality (adjusted HR 1.20, 95% CI 1.18–1.23, and adjusted HR 1.17, 95% CI 1.08–1.26, respectively). The association was partly mediated by the presence of a psychiatric disorder.In summary, independent of a wide range of covariates, our results suggest that infections during brain development could be part of the genesis of violent criminal behavior.     

Modifying the behavior of the violent patient

Different behavioral techniques are briefly described for treating the violent patient in a hospital setting. Emphasis is placed on doing a careful assessment of the situation and behavior before attempting a behavioral intervention. It is also emphasized that all staff members involved be adequately trained, otherwise the procedures tend to fail. Techniques include strategies for changing the environment, as well as using relaxation procedures, systematic desensitization, differential reinforcement schedules, token economies, response cost, time out, and social skills training. Multi-component programs are also briefly mentioned. The paper emphasizes that violent behavior can be greatly reduced if approached in a systematic way, using procedures based on sound research methodology.     

Minor physical anomalies and family adversity as risk factors for violent delinquency in adolescence

OBJECTIVE: Minor physical anomalies are considered indicators of disruption in fetal development. They have been found to predict behavioral problems and psychiatric disorders. This study examined the extent to which minor physical anomalies, family adversity, and their interaction predict violent and nonviolent delinquency in adolescence. METHOD: Minor physical anomalies were assessed in a group of 170 adolescent boys from low socioeconomic status neighborhoods of Montréal. The boys had been enrolled in a longitudinal study since their kindergarten year, when an assessment of family adversity had been made on the basis of familial status and the parents' occupational prestige, age at the birth of the first child, and educational level. Adolescent delinquency was measured by using self-reported questionnaires and a search of official crime records. RESULTS: Results from logistic regression analyses indicated that both the total count of minor physical anomalies and the total count of minor physical anomalies of the mouth were significantly associated with an increased risk of violent delinquency in adolescence, beyond the effects of childhood physical aggression and family adversity. Similar findings were not found for nonviolent delinquency. CONCLUSIONS: Children with a higher count of minor physical anomalies, and especially a higher count of anomalies of the mouth, could be more difficult to socialize for different and additive reasons: they may have neurological deficits, and they may have feeding problems in the first months after birth. Longitudinal studies of infants with minor physical anomalies of the mouth are needed to understand the process by which they fail to learn to inhibit physical aggression.     

精神分裂症危险行为相关因素的研究现状

<正>精神分裂症危险行为包括由于疾病引起的暴力、滋事、肇事、肇祸等行为。暴力是指严重的、强烈的、突然的对他人身体或财物直接进行攻击,包括打击、侵袭、伤害、甚至杀害;滋事是指肆意挑衅,随意殴打、骚扰他人或任意损毁、占用公私财物,或在公共场所起哄闹事;肇事是指违反《治安管理条例》的行为;肇祸是指违反《刑法》的行为。研究者对其发生的社会心理学及生物学相关因素和干预措施进行大量研究,本文就这些相关因素     

The etiology of violent behavior: An overview

Society often considers violent people to be mentally ill, and a significant number of patients exhibit violent behavior. For the assessment of violent individuals, a thorough understanding of the complex biopsychosocial causes of violence is required. This paper critically reviews recent investigations of the multiple causes of violence to clarify those aspects that can be helpful to clinicians in their inquiries.     

Premorbid adjustment and violent behavior in schizophrenic patients

We examined the influence of premorbid adjustment on violent behavior in schizophrenic patients. There is some evidence that poor premorbid adjustment predicts violent behavior, then we decided to examine this hypothesis further. METHOD: We recruited 72 schizophrenic patients without concomitant substance abuse 6 months prior to the assessment. Diagnoses were based on the SCID-I. Premorbid adjustment was evaluated with the Premorbid Adjustment Scale and violent behaviors with the Overt Aggression Scale. RESULTS: Violent schizophrenic patients showed an overall worse premorbid adjustment during childhood. In addition, the area of "peer relationships" was significantly diminished in several life period sections such as childhood, early and late adolescence in violent patients. DISCUSSION: Our data indicate that difficulties in social relationships during early stages of life may increase the risk of future violent behavior among schizophrenic patients.     

Neuropsychological deficits and violent behavior in incarcerated schizophrenics

The authors studied 37 male schizophrenics in a county jail psychiatric unit. Subjects were classified as impaired or not according to Luria-Nebraska Neuropsychological Battery criteria. Twelve of the 37 patients were impaired. Violence ratings were made on inpatient behavior and adult criminal records. Impairment status was related to adult history of violence but not inpatient violence. The most violent patients (by criminal record) were from the impaired category.     

Clozapine reduces violent behavior in heterogeneous diagnostic groups

Violent behavior is a significant problem in the psychiatric hospital setting. Persistently violent patients often require seclusion and/or restraints and typically receive high doses of medication and polypharmacy. Clozapine has been found to be effective in reducing aggression in patients with psychosis. Thus, we examined the effects of clozapine in a heterogeneous group of persistently violent patients. A chart review of the effect of clozapine in persistently violent patients was performed. Changes in the number of violent episodes and the need for seclusion and restraint were assessed for a 3-month period before and after receiving clozapine. In this group of five, carefully selected, persistently violent patients, clozapine treatment resulted in marked decreases in violent episodes and the use of seclusion and restraint. These data suggest a role for clozapine in the treatment of persistently violent patients irrespective of DSM-IV diagnosis.     

Neurobiological correlates of violent behavior among persons with schizophrenia

Men and women who develop schizophrenia are at increased risk, compared with the general population, to engage in violence toward others. The reasons for this robust finding remain obscure. We undertook a review of studies comparing neuropsychological test performance, neurological soft signs, and structural brain images of persons with schizophrenia with and without a history of violence. Our search identified 17 studies. The results are inconsistent and contradictory, mainly due to varying definitions of violence, differences in sample characteristics, and the use of diverse measures to tap the neurobiological correlates of violent behavior. The results suggest, however, that among men with schizophrenia, those who have displayed a stable pattern of antisocial and aggressive behavior since childhood, as compared with those with no such history, perform better on neuropsychological tests tapping specific executive functions and more poorly on assessments of orbitofrontal functions, show fewer neurological soft signs, and display larger reductions in volume of the amygdalae, more structural abnormalities of the orbitofrontal system, more abnormalities of white matter in the amygdala-orbitofrontal system, and smaller reductions in volumes of the hippocampus.     

Assessment of potential risk factors associated with ischaemic colitis.

Ischaemic colitis (IC) has been associated with a number of diverse disorders and risk factors, including irritable bowel syndrome (IBS) and constipation. We sought to assess, through a large-scale population study, the potential risk factors associated with IC. Patients with IC and matched controls without IC were identified using the medical and pharmacy claims data from the HealthCore Managed Care Database from 1st January 2000 to 31st May 2005. A multivariate conditional logistic regression model was developed to identify significant risk factors of IC. Interactions of age, sex, prior IBS diagnosis, and prior constipation diagnosis were further evaluated. We identified 1754 patients with IC and 6970 non-IC controls; 64% were women, and mean ages were 63 and 62 years respectively. The final parsimonious model comprised 19 independent variables associated with increased risk for IC including shock, dysentery, bloating, IBS, colon carcinoma, constipation, cardiovascular disease, dyspepsia, abdominal, aortic, or cardiovascular surgery, 12-month laxative, H(2) receptor blocker and oral contraceptive use. A significant interaction was observed between age and prior IBS on risk for IC. In conclusion, multiple risk factors for IC were identified and we confirmed that patients with IBS or constipation are at greater risk for IC.     

Gender differences in risk factors of suicidal behavior in epilepsy

The current study was performed to determine possible gender differences among risk factors for suicidal behavior in epilepsy. A special rating scale for assessment of suicidality was designed. The risk of suicide attempt was higher in epilepsy with concomitant diagnoses of organic affective disorder (F=06.3, ICD-10) and cognitive impairment (F=07.62, ICD-10). Risk was higher among females than males. Early age of epilepsy onset and high frequency of secondary generalized, simple partial, and all seizures were risk factors for suicidality in males, whereas low frequency of complex partial seizures was the risk factor in females. Daily dose of a classic antiepileptic drug was a risk factor for males, whereas daily dose of phenobarbital was a risk factor for both genders. Daily dose of carbamazepine and valproate is inversely correlated with suicidal behaviour in women, but not in men. The results obtained are discussed in the context of a paradigm of gender dimorphism as an indicator of evolution of Homo sapiens.     

Cultural risk factors of suicidal behavior among adolescents in Kazakhstan

Youth suicide is becoming a serious problem in Kazakhstan. According to UNICEF reports, the risk of suicidal behavior among adolescents (15–19 years) in Kazakhstan is three times higher than in the Commonwealth of Independent States (CIS). Despite the urgency of the problem, there are currently no psychological studies of the causes of suicide. In this article, we identify several cultural and historical factors and associated risks that, in our opinion, should be considered in the study of the growth of adolescent suicide in Kazakhstan.     

Toward a rational pharmacotherapy for aggressive and violent behavior

A substantial body of research with both animals and humans demonstrates that pharmacologic modulation of three neurotransmitter systems (the GABAergic, the noradrenergic, and the serotonergic) and electrical stimulation of regions of the brain produce marked alterations in aggressive and violent behavior. The author reviews this research and uses case reports to illustrate how it has been applied in the development of a rational pharmacotherapy for violent patients. Four basic principles of clinical application that can enhance trials of pharmacologic treatment of the violent patient are identified. Evidence suggests that behavioral and social learning approaches to the treatment of violence can be more effective when administered after the patient has been stabilized through pharmacologic interventions.     

Minor physical anomalies and recidivistic adult violent criminal behavior

Minor physical anomalies (MPA) result from disruptions of gestation, and may be used as signs of central nervous system defects in development. Utilizing a Danish birth cohort, we tested the hypothesis that MPA predict adolescent and adult recidivistic violent criminal behavior. The number of MPA was measured at 11 to 13 years of age and police records of criminal behavior were ascertained at 20 to 22 years of age. Recidivistic violent offenders evidenced an elevated level of MPA compared with subjects with one violent offense or subjects with no violent offenses.     

Aggressive and violent behavior in a population of psychiatric inpatients

The aim of this observational study was to assess the rates of aggressive and violent behavior in patients admitted to an Italian emergency psychiatric unit and to explore possible risk factors for patient violence. In a population of 313 consecutive patients, we considered aggressive or violent behavior, rated according to a hierarchy from no aggressive behavior to serious physical violence. The results confirm that young age, psychotic symptoms, excitement, akathisia, and diagnosis of personality disorder are risk factors for violent behavior. The unique and major finding of the study is the low prevalence of aggressive and violent acts in this sample of patients, possibly related to their cultural background and to the system of psychiatric care. These data provide supportive evidence for the importance of sociocultural factors in the behavior of psychiatric patients and suggest the need to explore new strategies of prevention and treatment of patient aggression and violence. A non-restraint policy could be a critical factor in reducing violence among psychiatric inpatients.     

A national study of violent behavior in persons with schizophrenia

CONTEXT: Violent behavior is uncommon, yet problematic, among schizophrenia patients. The complex effects of clinical, interpersonal, and social-environmental risk factors for violence in this population are poorly understood. OBJECTIVE: To examine the prevalence and correlates of violence among schizophrenia patients living in the community by developing multivariable statistical models to assess the net effects of psychotic symptoms and other risk factors for minor and serious violence. DESIGN: A total of 1410 schizophrenia patients were clinically assessed and interviewed about violent behavior in the past 6 months. Data comprise baseline assessments of patients enrolled in the National Institute of Mental Health Clinical Antipsychotic Trials of Intervention Effectiveness. SETTING AND PATIENTS: Adult patients diagnosed as having schizophrenia were enrolled from 56 sites in the United States, including academic medical centers and community providers. MAIN OUTCOME MEASURES: Violence was classified at 2 severity levels: minor violence, corresponding to simple assault without injury or weapon use; and serious violence, corresponding to assault resulting in injury or involving use of a lethal weapon, threat with a lethal weapon in hand, or sexual assault. A composite measure of any violence was also analyzed. RESULTS: The 6-month prevalence of any violence was 19.1%, with 3.6% of participants reporting serious violent behavior. Distinct, but overlapping, sets of risk factors were associated with minor and serious violence. "Positive" psychotic symptoms, such as persecutory ideation, increased the risk of minor and serious violence, while "negative" psychotic symptoms, such as social withdrawal, lowered the risk of serious violence. Minor violence was associated with co-occurring substance abuse and interpersonal and social factors. Serious violence was associated with psychotic and depressive symptoms, childhood conduct problems, and victimization. CONCLUSIONS: Particular clusters of symptoms may increase or decrease violence risk in schizophrenia patients. Violence risk assessment and management in community-based treatment should focus on combinations of clinical and nonclinical risk factors.