Among violent offenders, PCL-R scores were positively associated with proactive aggression, while experiences of childhood maltreatment were not. This finding concurs with previous studies of children and adults and suggests that proactive aggression may be a behavioural marker of psychopathic traits. By contrast, childhood physical abuse was associated with reactive aggression, even among violent offenders with high PCL-R scores. This latter finding suggests a strong influence of childhood physical abuse on the development of reactive aggression that persists over the lifespan.

Violent offenders with psychopathy present a lifelong pattern of callousness and aggression and fail to benefit from rehabilitation programs. This study presents the first, albeit preliminary, evidence suggesting that some of the structural brain anomalies distinguishing violent offenders with psychopathy may result from physical abuse in childhood.

Objective: To document experiences of childhood maltreatment among violent offenders with antisocial personality disorder (ASPD) distinguishing between those with and without the syndrome of psychopathy (+P and -P), and to determine whether maltreatment is associated with proactive and reactive aggression. Method:The sample included 10 violent offenders with ASPD+P, 15 violent offenders with ASPD-P, and 15 nonoffenders. All participants completed interviews with the same forensic psychiatrist focusing on physical, sexual, and emotional abuse prior to age 18 using the Early Trauma Inventory. Aggression was assessed using the Reactive-Proactive Questionnaire.Results: Violent offenders with ASPD+P reported significantly more severe childhood physical abuse, but not more sexual or emotional abuse, than violent offenders with ASPD-P and nonoffenders. Psychopathy Checklist-Revised (PCL-R) scores, but not childhood physical abuse, were associated with proactive aggression. Childhood physical abuse was associated with reactive aggression, as was an interaction term indicating that when both PCL-R scores and childhood physical abuse were high, so was reactive aggression.Conclusions: Among violent offenders, PCL-R scores were positively associated with proactive aggression, while experiences of childhood maltreatment were not. This finding concurs with previous studies of children and adults and suggests that proactive aggression may be a behavioural marker of psychopathic traits. By contrast, childhood physical abuse was associated with reactive aggression, even among violent offenders with high PCL-R scores. This latter finding suggests a strong influence of childhood physical abuse on the development of reactive aggression that persists over the lifespan. W W W

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SUMMARYClozapine, the antipsychotic of choice for treatment-resistant schizophrenia, has a number of side-effects, some of which are potentially life-threatening. Historically viewed as a relatively minor side-effect, there is increasing awareness of the potentially severe sequalae of constipation secondary to clozapine-induced gastrointestinal hypomotility (CIGH). These include ileus, intestinal obstruction, bowel ischaemia, gastrointestinal necrosis, toxic megacolon and death. CIGH is significantly more common than clozapine-induced blood dyscrasias and has a higher mortality rate. Although strict criteria must be followed to assertively monitor, detect and treat blood dyscrasias in patients taking clozapine, no such framework exists for CIGH. We recommend that prescribing guidelines, regulatory agencies and information from manufacturers should more clearly highlight the risks identified in the literature. Furthermore, we recommend that, in people taking clozapine, constipation should be prevented by prophylactic treatment with laxatives rather than treated only when clinically identified.LEARNING OBJECTIVES:After reading this article you will be able to: •understand the mechanism of gastrointestinal hypomotility in those taking clozapine•improve the monitoring of clozapine-induced constipation•understand prophylactic laxative treatment and the use of less commonly prescribed laxatives in patients who experience clozapine-induced constipation.