Managing the violent patient: A guide for psychologists and other mental health professionals.

Being threatened, harassed, attacked, or confronted by a patient with a weapon is becoming more common and is likely to occur at some point in a mental health professional's career. Effective violence management programs can reduce the incidence of violence. Yet, few resources have been provided to assist psychologists and other mental health professionals to deal with aggressive patients. The authors offer strategies for the management of aggressive behavior that can be implemented to empower practitioners to take precautions when necessary in a quick and efficient manner when dealing with violent and potentially violent patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Criminal thinking as a mediator of the mental illness–prison violence relationship: A path analytic study and causal mediation analysis.

Although mental illness and violence correlate, it has been speculated that this relationship is mediated by a series of third variables. The current study examined the possibility that the relationship between mental illness and prison violence is mediated by criminal thinking. General criminal thinking, as measured by the General Criminal Thinking (GCT) score of the Psychological Inventory of Criminal Thinking Styles (PICTS; Walters, 1995), was tested as a possible mediator of the mental illness–prison violence relationship. Using a prospective design and path analytic statistical technique, it was determined that general criminal thinking served as a partial mediator of the mental illness-institutional violence nexus in a sample of 2,487 male prison inmates. Causal mediation analysis also documented the presence of a small but statistically significant mediating role for general criminal thinking in this study. The implications of these results for understanding, predicting, and managing violent behavior in severely mentally ill inmates are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

A longitudinal investigation of interpersonal violence in relation to mental health and substance use.

The authors examined longitudinally the mental health status of women as a function of different types and combinations of exposure to interpersonal violence. A structured telephone interview was administered to a household probability sample of 4,008 women (18-89 years of age), who were then recontacted for 1- and 2-year follow-up interviews. Interviews assessed lifetime violence history (i.e., sexual assault, physical assault, witnessed serious injury or violent death), past-year mental health functioning (i.e., posttraumatic stress disorder [PTSD], depression, and substance use problems), and new instances of violence occurring after the baseline interview. Results indicate that (a) lifetime violence exposure was associated with increased risk of PTSD, depression, and substance use problems; (b) odds of PTSD, depression, and substance use problems increased incrementally with the number of different types of violence experienced; (c) relations were fairly stable over a 2-year period; and (d) new incidents of violence between the baseline and follow-up interviews were associated with heightened risk of PTSD and substance use problems. Greater understanding of the cumulative impact of violence exposure will inform service provision for individuals at high risk. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The prevalence of allergic rhinitis and nasal symptoms in Nottingham

An overview of the most important older and newer results regarding the relationship between violent and criminal behavior on the one hand and schizophrenic illness on the other hand is presented. Four different methods are available to study this relationship: (i) study of the prevalence of mental illness in criminal/violent populations; (ii) study of criminality/violence rate in samples of psychiatric patients; (iii) study of criminality/violence in community samples comparing mental patients with non-patient community residents; and (iv) study of criminality/violence in birth cohorts prospectively. All these methods have been used; but samples composed of schizophrenic patients exclusively were only exceptionally studied. The results indicate that there is a modest but significant relationship between schizophrenia and violence and crime which persists even after controlling for demographic and socio-economic variables. The probability of schizophrenic patients to be criminal or violent depends on the acuity of their illness and is increased by their use of psychoactive substances. Generally, however, violent and criminal acts directly attributable to mental illness account only for a very small proportion of such acts in the society.     

Partner violence before and after individually based alcoholism treatment for male alcoholic patients.

This study examined partner violence in the year before and the year after individually based, outpatient alcoholism treatment for 301 married or cohabiting male alcoholic patients and used a demographically matched nonalcoholic comparison sample. In the year before treatment, 56% of the alcoholic patients had been violent toward their female partner, 4 times the rate of 14% in the comparison sample. In the year after treatment, violence decreased significantly to 25% of the alcoholic sample but remained higher than in the comparison group. Among remitted alcoholics after treatment, violence prevalence of 15% was nearly identical to the comparison sample and half the rate among relapsed patients (32%). Thus, partner violence decreased after alcoholism treatment, and clinically significant violence reductions occurred for patients whose alcoholism was remitted after treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Violent thoughts and violent behavior following hospitalization for mental disorder.

Using a standardized schedule of questions, this study examined (a) the prevalence of self-report of violent thoughts by patients hospitalized for mental disorders compared with nonpatients, (b) the persistence of violent thoughts after discharge, and (c) the relation between patients' violent thoughts while hospitalized and violent acts within 20 weeks after hospital discharge. About 1/3 of the patients reported thoughts of violence while hospitalized, more than twice the proportion found among nonpatients. Reporting violent thoughts in hospital was significantly related to engaging in violent acts within 20 weeks after discharge for non-White patients, patients without major mental disorder but with substance abuse diagnoses, patients with high symptom severity, and patients whose reports of violent thoughts persisted after discharge. Reporting violent thoughts was significantly related to measures of psychopathy, anger, and impulsiveness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Workplace violence: Prevention, response, and recovery.

Describes a model of collaboration between business leaders and mental health clinicians in developing programs and strategies to prevent violence, handle acute crises, and cope with recovery and rebuilding in the aftermath of a workplace violence incident. Sections address the following: (1) demographics, costs, and risk factors and warning signs of workplace violence; (2) workplace violence prevention policies, including hiring, discipline, and termination practices; (3) responses to emergencies, such as potentially dangerous situations, violent episodes, and guns or weapons in the workplace; and (4) strategies for recovery following workplace violence that involve mental health and law enforcement mobilization, dealing with the media, assisting employees and families, legal issues, identification and treatment of posttraumatic stress disorder (PTSD), and follow-up procedures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interpersonal violence and mental health outcomes among Asian American and Native Hawaiian/other Pacific Islander college students.

In a cross-sectional survey of college students (N = 614), we studied interpersonal violence victimization, perpetration, and mental health outcomes in an ethnoracially diverse rural-based sample of Asian Americans (27%) and Native Hawaiian/Other Pacific Islanders (25%), two groups vastly underrepresented in trauma research. High rates of interpersonal violence (34%), violence perpetration (13%), and probable psychiatric diagnoses (77%), including posttraumatic stress disorder, were found. Exposure to physical violence, sexual violence, and life stress all were predictive of psychopathology. Female participants were associated with higher likelihood of sexual violence victimization compared to male participants, and Asian American status (especially among males) was associated with lower likelihood of physical and sexual violence compared with European Americans. These data enhance our understanding of interpersonal violence and mental health outcomes among previously understudied minority groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stressors in families with a child with a chronic condition: an analysis of qualitative studies and a framework

Prediction of violence in capital sentencing has been controversial. In the absence of a scientific basis for risk assessment, mental health professionals offering opinions in the capital sentencing context are prone to errors. Actuarial or group statistical data, known as base rates, have proven far superior to other methods for reducing predictive errors in many contexts, including risk assessment. Actuarial follow-up data on violent recidivism of capital murderers in prison and post release have been compiled and analyzed to demonstrate available base rates for use by mental health experts conducting risk assessments pertaining to capital sentencing. This paper also reviews various methods for individualizing the application of base rates to specific cases.     

Partner Violence Before and After Couples-Based Alcoholism Treatment for Male Alcoholic Patients: The Role of Treatment Involvement and Abstinence.

This study examined partner violence before and after behavioral couples therapy (BCT) for 303 married or cohabiting male alcoholic patients and used a demographically matched nonalcoholic comparison sample. In the year before BCT, 60% of alcoholic patients had been violent toward their female partner, 5 times the comparison sample rate of 12%. In the 1st and 2nd year after BCT, violence decreased significantly from the year before BCT, and clinically significant violence reductions occurred for patients whose alcoholism was remitted after BCT. Structural equation modeling indicated that greater treatment involvement (attending BCT sessions and using BCT-targeted behaviors) was related to lower violence after BCT and that this association was mediated by reduced problem drinking and enhanced relationship functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive control differences in violent juvenile inpatients

A stepwise discriminant analysis was used on a calibration sample (n = 135) of dangerous and nondangerous juvenile inpatients to determine which demographic, psychosocial, and cognitive variables best distinguished the violent inpatients. The resulting statistical model was cross-validated on the remainder of the sample (n = 123). Results show that the violent inpatients were more likely to be younger males whose family had a history of criminal behavior and extensive family discord. Moreover, the cognitive variables showed that violent inpatients showed differences in attention and memory, especially when they were processing aggressive stimuli. Results are discussed in terms of the potential ability of cognitive psychology to adopt an ecological perspective and to contribute to forensic assessment.     

Mental illness and violence: an epidemiological appraisal of the evidence

OBJECTIVE: To conduct a critical review of the literature on the matter of mental illness and violence, to examine whether there is enough evidence to establish a causal link, and to provide epidemiological background to measure the risk to the population. METHOD: Based on a computerized search of the literature on mental illness and violence previously conducted for Health Canada, studies in the area were critically reviewed and divided into 3 main categories: 1) studies of criminal and violent behaviour among psychiatric patients, 2) studies of psychiatric illness among offenders (prevalence studies in institutions, analytical studies, and community follow-up of offenders), and 3) epidemiological community-based studies on the issue of mental illness and violence (police-citizen encounters, representative samples, and other epidemiological studies). Causality rules and measures of risk were then applied to the evidence elicited. RESULTS: The review of the literature suggests that only a small minority of hospitalized patients, typically those suffering from acute psychotic symptoms, are involved in violent incidents. Formerly hospitalized patients are at a higher risk of committing violence if they are not properly treated and are experiencing threat/control-override psychotic symptoms. Substance abuse disorders significantly raise the risk for violence. Family members are the most at risk of being victimized. CONCLUSION: An association exists between mental illness and violence, but the many covariations that naturally affect the equation between them introduce uncertainties in establishing causality.     

Partner violence before and after couples-based alcoholism treatment for female alcoholic patients.

This study examined partner violence before and in the 1st and 2nd year after behavioral couples therapy (BCT) for 103 married or cohabiting women seeking alcohol dependence treatment and their male partners; it used a demographically matched nonalcoholic comparison sample. The treatment sample received M = 16.7 BCT sessions over 5–6 months. Follow-up rates for the treatment sample at Years 1 and 2 were 88% and 83%, respectively. In the year before BCT, 68% of female alcoholic patients had been violent toward their male partner, nearly 5 times the comparison sample rate of 15%. In the year after BCT, violence prevalence decreased significantly to 31% of the treatment sample. Women were classified as remitted after treatment if they demonstrated abstinence or minimal substance use and no serious consequences related to substance use. In Year 1 following BCT, 45% were classified as remitted, and 49% were classified as remitted in Year 2. Among remitted patients in the year after BCT, violence prevalence of 22% did not differ from the comparison sample and was significantly lower than the rate among relapsed patients (38%). Results for male-perpetrated violence and for the 2nd year after BCT were similar to the 1st year. Results supported predictions that partner violence would decrease after BCT and that clinically significant violence reductions to the level of a nonalcoholic comparison sample would occur for patients whose alcoholism was remitted after BCT. These findings replicate previous research among men with alcoholism. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Use of mental health services among victims of crime: Frequency, correlates, and subsequent recovery.

The use of mental health services was examined within a sample of 392 victims of crime who were generally representative of that population in Kentucky. Respondents were interviewed twice at a 6-month interval. Of these victims, 12% had contact with mental health professionals within the first few months postcrime. Hierarchical discriminant analyses revealed that use of mental health services was most prevalent when depressive symptoms were present and the crime involved violence. Among victims of violence, urban residence, high social support, internal locus of control, and prior crime experience were also associated with use. The victims who recovered from the event most rapidly were those who reported receiving mental health services at both Waves 1 and 2. Implications of the study for policies and programs are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interaction between birth complications and early maternal rejection in predisposing individuals to adult violence: specificity to serious, early-onset violence

OBJECTIVE: The authors previously reported that birth complications interact with early maternal rejection in predisposing individuals to violence at age 18 years. This study extended the follow-up period for violent offending from 18 years to 34 years, thus increasing the sample of violent offenders threefold and allowing more detailed analyses on onset and type of violence, the form of maternal rejection, and the effect of maternal mental illness. METHOD: Complications in the births of 4,269 males in Denmark, maternal rejection of these individuals before the age of 1 year, and their histories of criminal offenses at age 34 years were assessed. RESULTS: The biosocial interaction previously observed held for violent but not nonviolent crime, was specific to more serious forms of violence and not threats of violence, held for early-onset but not late-onset violence, and was not accounted for by psychiatric illness in the mothers. Being reared in a public care institution in the first year of life and the mother's attempt to abort the fetus were the key aspects of maternal rejection that interacted with birth complications in predisposing a subject to violence. CONCLUSIONS: These findings 1) indicate that the mechanisms underlying early-onset, serious violence differ from those for less serious, late-onset violence, 2) implicate very early factors in the development of violence, 3) highlight the potential importance of integrating psychosocial with biological factors in understanding and preventing violence, and 4) suggest that interventions to reduce birth complications and maternal rejection may help reduce violence.     

Do subtypes of maritally violent men continue to differ over time?

In previous batterer typology studies, only 1 study gathered longitudinal data and no research examined whether subtypes continue to differ from one another over time. The present study did so. We predicted that, at 1.5- and 3-year follow-ups, the subtypes identified at Time 1 (A. Holtzworth-Munroe, J. C. Meehan, K. Herron, U. Rehman, G. L. Stuart, 2000; family only, low level antisocial, borderline/ dysphoric, and generally violent/antisocial) would continue to differ in level of husband violence and on other relevant variables (e.g., generality of violence, psychopathology, jealousy, impulsivity, attitudes toward violence and women). Although many group differences emerged in the predicted direction, not all reached statistical significance, perhaps because of small sample sizes. Implications of the findings (e.g., not all marital violence escalates; possible overlap of the borderline/dysphoric and generally violent/antisocial subgroups) are discussed, as are methodological issues (e.g., need for more assessments over time, the instability of violent relationships). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Development of personality disorder symptoms and the risk for partner violence.

In a community sample (N = 543) followed over 20 years, the authors studied associations among childhood family violence exposure, personality disorder (PD) symptoms, and adult partner violence. PD symptoms (DSM-III-R Clusters A, B, and C) in early adulthood partially mediated the effect of earlier childhood risks on the odds of perpetrating partner violence. The authors tested whether stability of PD symptoms from adolescence to the early 20s differs for individuals who later perpetrated partner violence. Cluster A ("Odd/Eccentric") symptoms declined less with age among partner violent versus nonviolent men and women. Cluster B ("Dramatic/Erratic") symptoms were more stable through late adolescence in partner violent men, compared with nonviolent men and violent women. Cluster C ("Anxious") symptoms were most stable among partner violent men. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-reported health and behavioral problems among adolescent victims of rape in France: results of a cross-sectional survey

OBJECTIVES: To measure the prevalence rate of rape among French adolescents; to analyze the associated health and behavioral problems; to analyze the use of the health care system by rape victims. METHOD: A national representative sample of 8,140 students attending public secondary schools in France (grades 8 to 12) filled in a self-administered questionnaire (274 questions) on health and behavior problems (acceptance rate = 87%). Each rape victim in the sample (n = 61) was matched to two nonvictims (n = 122). RESULTS: The reported prevalence rate of rape was .8% (.9% among girls, .6% among boys). For both boys and girls, there was a relationship between rape and current sleep difficulties, depressive symptoms, somatic complaints, tobacco consumption, and behavior problems (running away, violent behavior, stealing, and school absenteeism). Additional problems were associated for boy rape victims: attempted suicide, regular use of alcohol and of illicit drugs. Rape victims did consult health professionals, but the majority saw neither a mental health specialist nor a social worker. CONCLUSION: The findings indicate that rape victims, especially boys, have more behavior problems and health problems than nonrape victims. Authors suggest that adolescents who have ran away from home, attempted suicide, or manifested violent behavior should be systematically asked about rape.     

Extended cervical mediastinoscopy

Organic solvent inhalation is a serious problem among youths in Japan. It induces physical and mental disorders, and is related closely to crime and delinquency. The relationship between solvent inhalation and antisocial behavior was investigated in 75 youths. The subjects were divided into three groups according to the level of violent behavior and the time of appearance: a non-violent group, a late-onset group (violence occurred after the start of inhalation) and an early-onset group (violence had occurred before the start of inhalation). Various parameters were compared among the groups. The late-onset group showed the following characteristics; (i) the frequency of inhalation was high, and many subjects experienced hallucinations and mood changes caused by inhalation; (ii) the family environment was characterized by conflict; and (iii) the subjects had strong psychological conflicts and showed dissociative coping with frustration. The violence, psychological conflict and dissociation in this group were found to be related to the inhalation, with familial conflict as a background. The violence in the early-onset group was considered to be the manifestation of a violent personality as the frequency of inhalation and the incidence of mental symptoms were both low. The subjects in this group showed weak psychological conflict and tended to be demanding of others when attempting to cope with frustration. Two types of violent behaviors in the teenagers who inhaled solvents were identified. The violence of solvent inhalers should be managed according to the type.