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.     

Temperament and character in homicidal patients with schizophrenia

Abstract

Background: Understanding the etiology of violence in patients with schizophrenia is an issue of great clinical and public importance. Although personality traits are an important aspect in determining complex behaviors of schizophrenia patients, there is a lack of research on the relationship between personality traits and violence, especially homicidal behavior, in this population.

Aim: We aimed to compare temperament and character dimensions between homicidal and other mostly violent forensic patients with schizophrenia, and to determine which temperament and character dimensions are associated with homicidal behavior in these patients.

Methods: We recruited 71 male forensic schizophrenia patients without concomitant substance dependence and antisocial personality disorder. The patients were divided into two groups according to trial documentation as: (1) Homicide and attempted homicide group (N 30; 42%), and (2) Other offenses group (N 41; 58%). Patients were assessed by means of the Temperament and Character Inventory and the Positive and Negative Syndrome Scale. Differences between groups were tested with t-test.

Results: The two groups of patients were similar in their PANSS scores, but the homicidal men were significantly more likely to show higher harm avoidance (HA) scores than the less violent comparison men (t?=?2,876, df-69, p?=?0.005).

Conclusions: Our results indicate that forensic schizophrenic patients with higher HA scores would show a greater risk of homicidal violence. Improved understanding of personality traits associated with such behavior is needed in order to prevent homicidal behavior. Importance of these results suggests that further study is needed.     

The influence of substance use on the effectiveness of antipsychotic medication: a prospective,pragmatic study

Abstract

Background: Psychosis is associated with a high prevalence of substance use, leading to worsened prognosis. Less is known about how comorbid substance abuse may influence the effectiveness of antipsychotic medications. The aim of this study was to compare the effectiveness of second generation antipsychotics in patients with psychosis with and without substance use.

Methods: All patients (n?=?226) were aged >18 years old had symptom level scores of ≥4 on selected psychosis items on the Positive and Negative Syndrome Scale and met ICD-10 diagnostic criteria for psychosis. Information on substance use was collected based on the Clinician Drug Use Scale. Patients were grouped at baseline according to the presence of substance use, medication history and diagnosis group. Clinical symptoms at baseline and changes at follow-up were assessed with the PANSS.

Results: At baseline about 30% of the patients used substances, most frequently cannabis followed by methamphetamine. About half (47%) of the patients had no prior exposure to antipsychotic medication at inclusion. Patients who had consumed substances showed no substantial differences in the PANSS score reduction as a result of antipsychotic medication compared to patients without substance. There were, however, some group differences in relation to pattern of change that were influenced by medication history. Substance use was found to be related to stronger reduction of positive symptoms from week 4 to week 27.

Conclusion: Substance use alone did not influence antipsychotic effectiveness in this sample of patients with psychosis.     

A multi-center,randomized controlled trial of a group psychological intervention for psychosis with comorbid cannabis dependence over the early course of illness

BackgroundPatients who experience the onset of psychotic illness with a comorbid diagnosis of cannabis dependence experience poor clinical outcomes. Few studies have identified interventions that reduce cannabis use and improve clinical outcome in this population.AimsWe undertook a multi-center, randomized controlled trial of a group psychological intervention for psychosis with comorbid cannabis dependence to determine whether there was any impact on cannabis use symptoms, global functioning, insight, attitudes to treatment and subjective quality of life.MethodAcross three centers, we compared a group psychological intervention, based on cognitive behavioral therapy and motivational interviewing, with treatment as usual among patients experiencing their first psychotic episode or early in the course of psychotic illness. Substance misuse and indices of clinical outcome were assessed at baseline, 3 months and 1 year.ResultsAt 3 month and 1 year follow-ups, there was no evidence for an intervention effect on cannabis use, symptoms, global functioning insight or attitude to treatment. However, the intervention improved subjective quality of life at 3 months and this effect was sustained at 1 year.ConclusionsOver the early phase of psychotic illness, group psychological interventions for those with comorbid cannabis dependence improved subjective quality of life. However, this was not associated with reduction in use of cannabis or improvement in clinical outcomes.     

Brain volumes differ between diagnostic groups of violent criminal offenders

Studies on structural abnormalities in antisocial individuals have reported inconsistent results, possibly due to inhomogeneous samples, calling for an investigation of brain alterations in psychopathologically stratified subgroups. We explored structural differences between antisocial offenders with either borderline personality disorder (ASPD-BPD) or high psychopathic traits (ASPD-PP) and healthy controls (CON) using region-of-interest-based and voxel-based morphometry approaches. Besides common distinct clusters of reduced gray matter volumes within the frontal pole and occipital cortex, there was remarkably little overlap in the regional distribution of brain abnormalities in ASPD-BPD and ASPD-PP, when compared to CON. Specific alterations of ASPD-BPD were detected in orbitofrontal and ventromedial prefrontal cortex regions subserving emotion regulation and reactive aggression and the temporal pole, which is involved in the interpretation of other peoples’ motives. Volumetric reductions in ASPD-PP were most significant in midline cortical areas involved in the processing of self-referential information and self-reflection (i.e., dorsomedial prefrontal cortex, posterior cingulate/precuneus) and recognizing emotions of others (postcentral gyrus) and could reflect neural correlates of the psychopathic core features of callousness and poor moral judgment. The findings of this first exploratory study therefore may reflect correlates of prominent psychopathological differences between the two criminal offender groups, which have to be replicated in larger samples.     

The New Actor of Involuntary Hospitalisation in France: The Juge des Libertés et de la Détention (Judge of Freedoms and Detention)

The practice of involuntary hospitalisation in which the patient is unable to give consent frequently occurs in France and has been legal since 1838. However, two reforms took place in 1990 and 2011. The latter introduced the systematic intervention of the judge of freedoms and detention. This new central actor in psychiatric care under duress was not without disruption to the daily practice of nursing. We propose to describe the theoretical and practical aspects of this new legislation.     

Mental Harm Claims Against Emergency Services Organisations: AnImportant Australian Development

The decision of Garling J in Benic v State of New South Wales [2010] NSWSC 1039 is a significant adverse finding for a plaintiff in the context of a police officer alleging afailure to provide him with a safe place of work. The decision was made in response to a claim for negligence arising out of alleged provision of an inadequate response to his complaints of threats to his life in the course of his employment. The fact that he was unable to prove either the requisite breach of a duty of care or causation between a breach and his psychiatric harm has the potential to be an important development in this form of psychiatric injury litigation in Australia. In particular, the court's reliance upon the National Clinical Practice Guideline No 26 – Post Traumatic Stress Disorder: The Management of PTSD in Adults and Children in Primary and Secondary Care (‘the NICE guidelines’) – in order to evaluate the likely consequence of early intervention after a traumatic experience has the potential to have important forensic ramifications for other cases.     

Civil Liability of Health Practitioners for their Forensic Work: Further Erosion of the Witness Immunity Rule Jones v Kaney [2011] UKSC 13; [2011] 2 All ER 671, [2011] 2 WLR 823

There is a clear evolution in the law toward allowing experts to be made more accountable for the discharge of their forensic functions. A particular manifestation of this has been decisions such as General Medical Council v Meadow [2006] EWCA Civ 1390; [2007] 1 QB 462 holding experts amenable to disciplinary hearings for their forensic reports and also for the testimony that they give in court. However, until recently the witness immunity rule has wholly protected experts from being sued in negligence or defamation for their forensic work. The decision of the United Kingdom Supreme Court in Jones v Kaney [2011] UKSC 13 has commenced to erode the rule, possibly laying the ground work for further erosion. However, such developments are unlikely to occur in Australia in the short to medium term, largely because of the High Court's retention of immunity for barristers, an advantage being that Australia will be able to assess the repercussions of the disincentives that may accrue in the United Kingdom to experts undertaking forensic functions.     

Non-credible language deficits following mild traumatic brain injury

Identification of non-credible memory and other cognitive symptoms has received widespread attention within the past two decades. However, minimal information is available regarding patterns of non-credible language symptoms. We present the case of a 36-year-old female civil litigant who displayed delayed onset, severe, relatively focal speech and language symptoms, including difficulties with articulation, dysfluent speech, expressive language impairments with minor receptive difficulties, and lack of prosody, subsequent to a minor head trauma. On neuropsychological evaluation 3 years post injury, the patient presented with the same speech/language characteristics, but additionally exhibited a vague “foreign accent.” Cognitive scores generally were normal with the exception of poor performance on many language tasks and processing/motor speed. The patient showed passing performance on most measures of response bias, but she failed effort indicators requiring rapid letter discrimination (b Test), rapid verbal repetition (timed forward digit span), and sensory function (finger agnosia errors) while passing effort indicators falling within the domains of memory, math/number skills, visuo-constructional ability, and attention. Thus, the type of failed effort indicators predicted the categories of standard cognitive tests on which she underperformed. Personality testing revealed patterns generally consistent with hysterical personality orientation. Given her long-standing history of multiple unexplained medical symptoms, the patient was diagnosed with a somatization disorder, as well as a current conversion disorder involving language symptoms. However, given her compensation-seeking status, the possibility of additional conscious feigning of symptoms could not be ruled out. The need for validation of additional measures to detect feigned language impairment is recommended.