Assessing the risk of violence in released mental patients: A cross-validation study.

A statistical scale to assess the probability of violence in released mental patients was developed and cross-validated. A calibration sample of 251 adult males admitted as inpatients to a community mental health center and considered potentially violent was obtained. Data collected at admission (including demographics, family background, criminal justice and mental health system contacts, past violent behavior, and current situational measures) were used to predict subsequent violent arrests or readmissions during a 1-year follow-up period with multiple regression. A statistical equation of 5 variables was derived and applied to a cross-validation sample of 265 male patients. The correlation between the scores and subsequent violence in this sample was .32. Classification using a cutoff point obtained from the calibration sample yielded 75.8% correctly classified and a false positive rate of 47.6%. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship between aggressive attributional style and violence by psychiatric patients.

The authors propose a new theoretical construct for understanding the risk of violent behavior by psychiatric patients: the aggressive attributional style. They propose that a cognitive style characterized by external hostile attributions increases the risk of violence by mentally ill persons. To evaluate this hypothesis, they administered several self-report measures relevant to the aggressive cognitive style, as well as measures of violent behavior in the community, to 110 psychiatric inpatients. Higher scores on several indicators of the aggressive attributional style were associated with violence. Multivariate logistic regression analyses showed that the relationship between attributional style and violence held up when demographic and diagnostic characteristics and impulsiveness were controlled. The authors discuss implications for development of cognitive interventions to reduce violence 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.     

Desensitization to media violence: Links with habitual media violence exposure, aggressive cognitions, and aggressive behavior.

This study examined the links between desensitization to violent media stimuli and habitual media violence exposure as a predictor and aggressive cognitions and behavior as outcome variables. Two weeks after completing measures of habitual media violence exposure, trait aggression, trait arousability, and normative beliefs about aggression, undergraduates (N = 303) saw a violent film clip and a sad or a funny comparison clip. Skin conductance level (SCL) was measured continuously, and ratings of anxious and pleasant arousal were obtained after each clip. Following the clips, participants completed a lexical decision task to measure accessibility of aggressive cognitions and a competitive reaction time task to measure aggressive behavior. Habitual media violence exposure correlated negatively with SCL during violent clips and positively with pleasant arousal, response times for aggressive words, and trait aggression, but it was unrelated to anxious arousal and aggressive responding during the reaction time task. In path analyses controlling for trait aggression, normative beliefs, and trait arousability, habitual media violence exposure predicted faster accessibility of aggressive cognitions, partly mediated by higher pleasant arousal. Unprovoked aggression during the reaction time task was predicted by lower anxious arousal. Neither habitual media violence usage nor anxious or pleasant arousal predicted provoked aggression during the laboratory task, and SCL was unrelated to aggressive cognitions and behavior. No relations were found between habitual media violence viewing and arousal in response to the sad and funny film clips, and arousal in response to the sad and funny clips did not predict aggressive cognitions or aggressive behavior on the laboratory task. This suggests that the observed desensitization effects are specific to violent content. (PsycINFO Database Record (c) 2011 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)     

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.     

Aggressive behaviour in children and adolescents. Part I: A review of the effects of child and family characteristics

Interpersonal violence is a major public health concern throughout the West Indies, particularly in Jamaica. Many factors contribute to a youth's violent or aggressive behaviour, ranging from individual temperament, to family structure, to large sociocultural influences. In Part I, we review the incidence and severity of violence, and discuss the effects of individual characteristics, and of family structure and discipline. In Part II, the reported effects of school structure, peer relationships and interaction, corporal punishment and the media on violent behaviour in children and adolescents are reviewed, and potential policy implications are discussed.     

Occupational allergic disease in cereal workers by stored grain pests

This review paper explored the concepts of risk assessment and management in relation to 'serious' violence by individuals with mental disorder. The paper highlighted the political context in which concern over serious violence by those with mental disorder is increasing. Government guidance on risk assessment was considered and identified as having an actuarial bias. Correlational studies, which provide actuarial indicators of risk, were explored and a picture was developed that demonstrated the difficulty of determining risk of violence to others simply on the basis of psychiatric symptomatology. The literature led to a conclusion that risk assessment for violence is an inexact science, and that actuarial indicators need to be supported by structured thorough clinical investigation. Legal concerns around the assessment and management of risk were also explored. The Health and Safety Executive model for risk management was explored in relation to the findings of the risk-assessment literature and the recommendations of reports into serious violent incidents. The model was shown to have potential utility in providing a legally sound framework for the assessment and management of risk of violence in mental disorder.     

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.     

Role of cognitive€motional mediators and individual differences in the effects of media violence on aggression.

Two experiments were conducted to test the hypothesis that observation of media violence elicits thoughts and emotional responses related to aggression. In Experiment 1, highly violent videotapes elicited more aggressive cognitions than did a less violent tape. This effect was moderated by the trait of stimulus screening. In Experiment 2, aggressive cognitions increased with the level of violence in the videotape, and physical assaultiveness influenced this effect. Hostility and systolic blood pressure were higher in response to the most violent video than in response to the other two. Hostility was influenced by emotional susceptibility and dissipation–rumination, and systolic blood pressure was influenced by emotional susceptibility and assaultiveness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

In the echoes of gunfire: Practicing psychologists' responses to school violence.

The recent rash of school shootings has thrust practicing psychologists into the role of assisting communities prevent such high profile incidents of juvenile violence. Although many psychologists are involved in assessing and treating children at risk for violent behavior, their efforts are rarely linked with other organized prevention efforts. This article describes how practicing psychologists represent a critical resource to school districts in developing and implementing a comprehensive violence prevention strategy. The authors outline a model school and mental health clinic collaborative program that can be replicated in various practice settings and discuss the benefits and essential steps for building such a collaboration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Affect, verbal content, and psychophysiology in the arguments of couples with a violent husband.

Studied the affect, psychophysiology, and verbal content of arguments in couples with a violent husband. On the basis of self-reports of violent arguments, there were no wife behaviors that successfully suppressed husband violence once it began; moreover, husband violence escalated in response to nonviolent as well as violent wife behaviors, whereas wife violence escalated only in reaction to husband violence or emotional abuse. Only wives were fearful during violent and nonviolent arguments. The observational coding of nonviolent arguments in the laboratory revealed that both battering husbands and their wives (DV) were angrier than their maritally distressed but nonviolent (DNV) counterparts. As predicted, on the more provocative anger codes, only DV men differed from their DNV counterparts. However, DV wives were as verbally aggressive toward their husbands as DV husbands were toward their wives. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

What Do Clinicians Expect? Comparing Envisioned and Reported Violence for Male and Female Patients.

Mental health professionals' (MHPs') accuracy in assessing the risk of violence in female patients is particularly limited. Based on assessments made by 205 MHPs of 605 patients in an emergency room, this study explored potential causes of MHPs' poorer accuracy in assessing women's potential for violence. The dimensions that underlie MHPs' envisioned violence in patients were identified and were compared with those that characterized patients' reported violence during a 6-month follow-up period. There were three key findings from their study. First, violence envisioned by MHPs differed depending on their professional role and varied in its congruence with patients' reported violence. Second, patients' violence was organized by dimensions of domesticity and substance relatedness; women's violent incidents were more domestic than were men's. Third, when MHPs envisioned violence that was highly conditional on psychiatric deterioration and medication noncompliance, violence often did not occur. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavioral and physiological reactions to observed violence: Effects of prior exposure to aggressive stimuli.

80 male undergraduates first watched videotaped sequences that were arousing, but which contained different degrees of violence. Ss then observed either a 2nd videotape of a sequence of aggressive acts or no videotape. Ss who were shown the 2nd videotape were told that the aggressive acts they saw were either justified or not justified, or were given no information regarding justification. It was found that Ss who had first seen an arousing but less violent tape were subsequently more aggressive toward an antagonist if they had observed justified violence. Ss who had first watched the violent videotape showed no differences in aggression as a function of the justification of the 2nd set of aggressive acts. Analysis of blood pressure data showed that prior exposure to violence attenuated arousal in response to subsequently observed aggression. The results are discussed in terms of differential sensitivity to cues that inhibit or disinhibit aggression. (9 ref) (PsycINFO Database Record (c) 2010 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)     

Violence and aggression in psychiatric units

OBJECTIVE: To help predict aggressive and violent behaviors, the frequency and types of these behaviors in acute psychiatric inpatient settings were examined, and potential interactions between staffing and patient mix and rates of the behaviors were explored. METHODS: Data on violent incidents were gathered prospectively in three adult acute psychiatric units in a general hospital and two units in a primary psychiatric hospital in Sydney, Australia. Staff recorded violent and aggressive incidents, which were ranked on an 8-level scale. They also completed weekly reports of staffing levels and patient mix. Poisson regression analysis was used to calculate relative rates, 95 percent confidence intervals, and p values. RESULTS: A total of 1,289 violent incidents were recorded over a seven-month period. Based on the scale, 58 percent of the incidents were serious. Seventy-eight percent were directed toward nursing staff. Complex relationships between staffing, patient mix, and violence were found. Relative risk increased with more nursing staff (of either sex), more nonnursing staff on planned leave, more patients known to instigate violence, a greater number of disoriented patients, more patients detained compulsorily, and more use of seclusion. The relative risk decreased with more young staff (under 30 years old), more nursing staff with unplanned absenteeism, more admissions, and more patients with substance abuse or physical illness. In total these factors accounted for 62 percent of the variance in violence. CONCLUSIONS: Violent incidents in psychiatric settings are a frequent and serious problem. Incidents appear to be underreported, and the seriousness of an incident does not guarantee it will be reported.