Schizophrenia and violence: study in a general psychiatric hospital with HCR-20 and MOAS

Abstract

Objective: This preliminary study aimed to identify and compare characteristics related to violent behavior in inpatients with schizophrenia at a general psychiatric hospital using the Historical, Clinical, and Risk Management 20 (HCR-20), the Modified Overt Aggression Scale (MOAS), and sociodemographic data. Method: Violent and nonviolent participants were selected based on psychiatric admission reports. Participants with reports of aggressive behavior and HCR-20 total score ≥ 21 upon admission were assigned to the violent patient group. Participants without aggressive behavior and with HCR-20 total score < 21 upon admission were assigned to the nonviolent patient group. The MOAS was applied to characterize the degree of severity of the violent behavior. Results: HCR-20 and its subscales were effective in differentiating between the violent and nonviolent participant groups. Twelve of the 20 HCR-20 items were useful for distinguishing between the groups, although total HCR-20 scores were more reliable when applied to the nonviolent patient group. The MOAS did not show high degrees of severity for the types of aggression observed in the participants. Conclusion: HCR-20 was useful and reliable for distinguishing between violent and nonviolent patients with schizophrenia in this clinical psychiatric setting. Item analysis identified the most relevant characteristics in each group. The use of the HCR-20 in clinical psychiatric settings should be encouraged.

Violent behavior by involuntarily committed female offenders with mental disorders: A population‐based case series

“…Factors such as age, gender, socioeconomic status, and prior violent behavior are important, as are other potentially amenable factors such as substance abuse, personality disorders, and regular use of psychiatric medications. Comorbidity with substance abuse increases the risk of aggressive behavior in individuals with severe mental disorders [29–34]. According to Jaffe et al [35], individuals with substance use disorders and comorbidity with mental disorders show lower success rates with drug dependence treatment and more involvement with the criminal justice system.…”

Mental illness and social exclusion: assessment of the risk of violence after release

“…El principal resultado del presente estudio es que la utilización de la guía HCR-20 se perfila como una útil herramienta para la valoración del riesgo de protagonizar futuros incidentes violentos tras la excarcelación, en el sujeto con trastorno mental grave que se encuentra en situación de exclusión social extrema (sinhogarismo), lo que se demuestra por su potencial validez predictiva para futuros incidentes violentos en los sujetos con antecedentes penitenciarios. Esta investigación es necesaria, ya que todavía se discuten las limitaciones de la guía HCR-20 como un instrumento de evaluación útil para los profesionales de la salud mental [13][14][15][16][17] .…”

“…En España, la HCR-20 ha sido adaptada por el Grupo de Estudios Avanzados en Violencia de la Universitat de Barcelona y publicada en castellano 13 . En los estudios tanto retrospectivos como prospectivos, la HCR-20 ha mostrado tener una buena validez predictiva [13][14][15][16][17] .…”

“…Se encontró que los no violentos (rango prome-dio=17,42) difirieron significativamente (p <0,001; U=44) en sus puntuaciones en la subescala histórica (H) en comparación con el grupo violento (rango promedio=34,62). Con respecto a la escala C, los dos grupos difirieron significativamente (p <0,001; U=30) en sus puntuaciones en la subescala clínica del HCR-20, resultando que el grupo de violentos tenía un rango promedio más alto (35,69) en comparación con el grupo no violento (16,97). Y también hubo una diferencia significativa (p=0,001; U=70,5) entre la media de las puntuaciones de la escala de administración de riesgos (R) del grupo violento (rango prome-dio=32,04) y no violento (rango promedio=18,50).…”

Violent behavior by women involuntarily committed to a forensic psychiatric hospital in Rio de Janeiro, Brazil

“…Factors such as age, gender, socioeconomic status, and prior crime are important, as are other potentially treatable factors such as substance abuse, personality disorders, and regular use of medications. Comorbidity with substance abuse increases the risk of aggressive behavior in individuals with severe mental disorders [28][29][30][31][32][33] . According to Jaffeet al .…”